...Studies have also stated that patients with a low risk of injury can undergo 3-projection cervical spine radiography.13 Plain-film radiographs can be insensitive for cervical spine injuries, with inadequate imaging rates of 37% to 72%. Inadequate images can occur due to, overlapping of the shoulder girdle and rib cage on the lateral projection, Suboptimal images, Patient size and body habitus, incorrect interpretations by physicians and incomplete visualization of the cervical spine from the skull base to T1. Some studies have also stated that NEXUS and CCR are inadequate and cervical spine fractures cannot be excluded without CT. CT imaging is the preferred method due to its high accuracy, speed, and ability to reconstruct images in the coronal...
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...the media. This past summer there were a few cases of NF on Galveston beaches. Most likely it was caused by the strain Dr. Edlich talks about in his paper Necrotizing Fasciitis:...
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...Stokes et al. BMC Health Services Research 2011, 11:135 http://www.biomedcentral.com/1472-6963/11/135 RESEARCH ARTICLE Open Access Impact of bleeding-related complications and/or blood product transfusions on hospital costs in inpatient surgical patients Michael E Stokes1*, Xin Ye2, Manan Shah3, Katie Mercaldi4, Matthew W Reynolds4, Marcia FT Rupnow2 and Jeffrey Hammond2 Abstract Background: Inadequate surgical hemostasis may lead to transfusion and/or other bleeding-related complications. This study examines the incidence and costs of bleeding-related complications and/or blood product transfusions occurring as a consequence of surgery in various inpatient surgical cohorts. Methods: A retrospective analysis was conducted using Premier’s Perspective™ hospital database. Patients who had an inpatient procedure within a specialty of interest (cardiac, vascular, non-cardiac thoracic, solid organ, general, reproductive organ, knee/hip replacement, or spinal surgery) during 2006-2007 were identified. For each specialty, the rate of bleeding-related complications (including bleeding event, intervention to control for bleeding, and blood product transfusions) was examined, and hospital costs and length of stay (LOS) were compared between surgeries with and without bleeding-related complications. Incremental costs and ratios of average total hospital costs for patients with bleeding-related complications vs. those without complications were estimated using ordinary...
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...management -GSWs most often injure the small bowel followed by the colon and liver Clinical thinking Does the patient have an adequate airway, and ability to protect it? Is the patient breathing? Is oxygenation and ventilation adequate? A GSW in the abdomen may penetrate the diaphragm and cause a significant thoracic injury -Does that patient have adequate blood volume and perfusion? How does the patient respond to resuscitation, does the pt take beta blockers that may mask an appropriate tachycardia? -evaluate the pts ability to follow commands and respond appropriately. Is neurological disability a central phenomenon from shock, or is there a direct spinal cord injury? The patient must always be adequately exposed to evaluate all injuries, don’t over look the axial, back, gluteal cleft, and perineum. Patients with penetrating abdominal injuries are best served by antibiotic therapy prior to operative intervention. Initial therapy should be broad, with coverage of both gram-positive and gram negative organisms. Current practice guidelines advise broad spectrum antibiotics prior to incision and throughout operation -tentanus toxoid upon admission The care of the trauma patient does not end with intraoperative repair of injuries. The hypothermic, coagulopathic laparotomy patient is prone to numerous postoperative complications: Expect...
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...presentation * absence of other explanation or other underlying disease * absence of cutaneous lesions * otherwise normal neuro exam * Proceed with imaging (MRI) if * Atypical Presentation * Slowly progressive over 2-3 weeks * If no improvement in symptoms in 6 wks * Electrophysiology (CMAP) performed if complete facial paralysis remains after 1 week of treatment Treatment * PT management: modalities, facial exercise, massage * Manual closing of eye such as with tape while sleeping, lubricating eye drops * Steroids * +/-Acyclovir * Surgical Decompression – no good evidence to support Prognosis * 80% recover within weeks to months * If motor nerve conduction studies show evidence of...
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...prevent earlier apparition of recurrences and chronicity in adulthood. Spinal pain Spinal pain appears due to variety of symptoms, which are experienced at least once in a lifetime by approximately 80% of a general population [1]. Classification of spinal pain concerns affected region (cervical, thoracic, lumbar, or irradiation in the limbs), duration (acute, sub-acute, chronic), or level of functional disability [1]. Lumbar pain is determined as a pain, muscle tension or stiffness that occurs between the last thoracic vertebra and the lower gluteal folds, with or without leg pain [1–3]. Chronic low back pain appears more often by working population in adulthood [1] and fluctuates during time, appears at different occurrences with different intensities and disability [4]. The complexity of symptoms could be associated with physical, psychical and recently genetic factors, as well most efficiently managed using multidisciplinary approach [5]. Spinal pain is common problem also among children and adolescents [3,6]. A cross-sectional study of 806 pupils in Denmark shows that children between 8-10 years suffer more from thoracic pain and 14 to 16 old adolescents equally from thoracic and low back pain, all together with a monthly prevalence of 39%...
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...Paramedic Case Studies Name Institution Table of Contents Introduction 3 1.1 Clinical plans are prior to arrival on the scene. 4 1.2 Patient selection Criteria for RSI 5 1.3 Steps in an RSI Procedure 6 Step 1 - Preparation 6 Step 2- Preoxygenation 6 Step 3- Pretreatment 7 Step 4- Rapid sequence Induction and Paralysis 7 Step 5- Protection and Positioning 7 Step 6- Placement of the Endotracheal Tube in the Trachea 8 Step 7- Post-intubation Management 8 1.4 Risks and benefits associated with RSI 9 Case 2 10 2.1 Discussion 10 2.2 Clinic plan and initial management 10 2.3 Notification of Arrival 11 Conclusion 11 Case 3 12 Introduction 12 Incident 1 12 Incident 2 13 Incident 3 13 Incident 4 14 Case 4 15 Conclusion 16 References 17 Introduction The basic concept of retrieval medicine is a combination of transfer and care of a patient from one medical institution, site of trauma, and pre-hospital management to a medical institution to provide higher and better level of care. The transfer and retrieval of severely ill and wounded patients entail high-risk activities (Ellis & Hooper, 2010). This paper looks into various case studies to determine the various control measures that might and should be put in place in various retrieval situations so as to increase patient safety and efficiency in pre-hospital care. This comprises of communication procedures, team resource management...
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...One of the reasons is the emergence of minimally invasive techniques like transcatheter aortic valve implantation (TAVI) and off-pump CABG (beating heart). http://bjcardio.co.uk/2011/02/impact-of-the-ageing-population-on-cardiac-surgery-in-the-uk/ The market potential for a device to provide treatment to heart valve sufferers in indicated in the Elsevier Business Intelligence article which reports that ‘15.6 million people worldwide suffer from rheumatic heart disease with approximately 282,000 new cases each year’ . (http://telavivmedtech.weebly.com/uploads/7/2/5/8/7258084/percutaneous_mitral_startup2012_2.pdf The problem is huge. Aortic stenosis is the most commonly diagnosed heart valve condition—annually roughly 300,000 patients worldwide, by conservative estimates, have been diagnosed with the disease. About one-third of them are not eligible for open-heart surgery due to age or other comorbidities. More than half of patients di-agnosed with the disease die within two years, according to FDA. http://www.mddionline.com/article/tavr-still-next-big-thing-cardiology 3. Patent Search Company Medtronic Edwards...
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...extremity. Examination of his shoulder girdles revealed an internally rotated left shoulder and shortened clavicular distance. He did have a visible deformation of his left clavicle when compared to the contralateral, uninjured side and had excruciating pain to palpation of the clavicular and sternoclavicular area. The patient had full flexion and extension at the elbow. Shoulder deltoid was intact as were internal and external rotation of his shoulder. Furthermore, the patient denied being short of breath, feeling dizzy, or with difficulty swallowing. Radiographs of the left clavicle and sternoclavicular joint (SCJ) at the initial visit were remarkable for a posterior dislocation of the clavicle. A magnetic resonance imaging (MRI) study of the left clavicle and SCJ revealed that it was posteriorly displaced and edema was present at the fracture site. The physeal attachment to the manubrium was intact. Furthermore, the anterior portion of the clavicle was abutting the brachiocephalic and left subclavian vein (Figure 1). The patient was admitted and a closed reduction was attempted. Postoperatively, the patient developed paresthesia of the fingers of his left hand. An urgent CT scan with contrast was performed to evaluate any potential bleeding from the subclavian vessels. No active bleeding was discovered, however, a retrosternal hematoma with mass-effect on the adjacent vasculature was identified and the...
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...A Hybrid Operating Suite at Community Medical Center Russell F Stahl, M.D., Carmen Sciandria, CCP, Cassandra Cuesta, BA The Evolution of Treatment of Cardiovascular Disease Surgery for coronary artery disease (CABG), valve repair and replacement, and the treatment of aortic disease, all have a remarkable history of success and evolution. Just as with computer technology, the trend in surgery has been to become smaller, faster and better. The treatment of cardiovascular disease (CVD) is moving towards less invasive and, in many cases, catheter based technologies. First interventional radiologists, then cardiologists, and now cardiac and vascular surgeons have embraced this trend. Clinicians are encouraged by outcomes that appear to be at least as good, albeit with trade-offs, and a high level of patient acceptance. Hybrid operating rooms - rooms combining operating room sterility and functionality with fixed angiography and echocardiographic imaging- are rapidly growing in prevalence and gaining increased interest from hospital administrators. These rooms are used by cardiac surgeons, vascular surgeons, interventional cardiologists, and neuro-interventionalists, and are suited for both open and closed procedures, as well as collaborative “hybrid” procedures. Given the dynamic nature of this room, these investments require thoughtful preparation operationally and logistically, especially when planning for physician and support staff that will work and cover call in this...
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...EXHIBITS No. 1 No. 2 3-19-14 Ltr, Turner to Richards 11-14-13 Deposition Transcript Excerpt 86 86 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Page 3 Uh-huh. MS. TURNER: Mr. Christensen, these are the medical records because we didn't print them all out. MR. CHRISTENSEN: I figured. And you had sent me those, but I appreciate you bringing them. We might open them up and refer to them, actually. Q. Did you happen to have in your file your billing for your services at all? A. No. Q. And why is that? A. My wife takes care of that so I don't keep a record with me of billing. Q. How does she typically do that? MS. TURNER: Objection. Foundation. Answer it if you know. A. I give her the hours that I spent working on the case and then she sends an invoice. Q. And where is the documentation for your hours? Is it on your handwritten notes? A. So up at...
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...Common symptoms Betty complained about was fatigue, arthritis pain and to the feet (Jackso, 2018, p.1). There were also feelings of numbness in the pelvis, soreness and burning, generalized pain. Betty only was prescribed Zoloft, however she declined to take it. Based on the evaluation with cranial sacral therapy, it was noted that she was restricted severely in the triad of compression (Jackso, 2018, p.1). There were also constrictions in the fascia and the thoracic diaphragm. She was prescribed with nine treatment sessions for one hour, greater than three months duration. After the first treatment, the patient reported improvement in her bladder function, which was not noted initially in the evaluation (Jackso, 2018, p.1). She also reported of not noticing the pain that presented throughout her entire body, and was willing to focus now more on the emotional trauma she encountered. She had somatoemotional release during a pelvic diaphragm release which allowed betty to elaborate about previous guilt she held onto from being in college about involvement with sex, guilt and abandonment. After each session, betty experienced more relief and each time she could share more emotionally to determine the primary cause of her pain (Jackso, 2018,...
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...151 Project Part A Abstract: This case study is about the application and effectiveness of massage modalities on resolving pain and tension issues based on chronic postural imbalances. In this case study there will be assessing of the client's conditions, facilitating techniques based on the symptoms and drawing conclusions of the efficacy of the applied techniques as a protocol for the given conditions. Introduction: 1. The therapeutic concern for my client is to relieve moderate and chronic pain that stems from the neck down the shoulder blade and into the upper arm and mid-back at rest and during daily activity. With the pain and tension comes a compromised active, passive, and resisted range of motion in the actions...
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...The ORIGINAL ARTICLE Heart the MVand Short StaturePolicy implications CASE REPORT Sinking of Failure Doña Paz – II. in a 43 year-old male Table 1. Initial Laboratory Results Heart Failure recommendations to address these to hypothyroidism. with cardiomyopathy secondary factors. The patient had been born full term to a then 31-yearMethod. ReviewPara 3 (G4P3), the 4th of preparedness in the old Gravida 4 of the state of maritime 9 siblings, with an pre-disaster setting and the post-disaster responsefacilitated the apparently unremarkable delivery at home following by Table 2. Thyroid Doña Paz by the sinking of the MV Function Tests government and responsible a traditional birth attendant. He was noted to be normal agencies. A scrutiny Reference Value preparedness of concerned of the state of Result at birth. and subsequent response to thewith age was agencies The patient was allegedly at par0.02 disaster both Free T4 (0.8-2.0) ng/dL physically and mentally until formulating 24.75 Uiu/ml conducted with the objective of eight years old when he was recommendations TSH (0.4-6.0) said to have stopped growing in height. He was brought to which may lead to prevention and mitigate loss of lives. a private doctor, whose diagnosis was undisclosed, and he Results. Multiple factors to increase for the occurrence patient was given medications accounted height, which the of this tragedy. only one month with no improvement. Through the took for These factors include an inherent risk due...
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...Robotic Surgery To Stay Or Not Too Stay The use of surgical robots has increased greatly and is continuing to grow. Although these robots are already being used they have advantages as well as disadvantages. Surgical robots are only going to improve the outcomes for the patients, surgeons, and hospitals and will keep improving as time goes on, overcoming the disadvantages that are seen today. Many different types of robots are being used to carry out surgical procedures such as the Endowrist, AESOP, Zeus, PROBOT, ROBODOC, SOCRATES and the da Vinci being the most popular. Also there are many specific types of surgical procedures that are being carried out robotically such as urological, gynecological, cardiac, and general surgeries. “Shorter hospital stays, smaller incisions, less blood loss, quicker recovery, less painful, reduced rates of bacterial infections and blood transfusions, eliminating the surgeons hand tremors, more comfort and decrease in fatigue for the surgeon, 3D view, superior suturing skills, reverse fulcrum” are some of the advantages that affect the patient. Disadvantages involved with robot assisted surgery are “high cost, the large size of the robot, lack of compatible instruments and equipment, lengthy set up times, longer operative times, lack of haptic tactile feedback,” but are believed to disappear with more research and time. Surgical robots could be the most successful and most used technology in surgery in the future. “A surgical robot...
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