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https://www.readbyqxmd.com/read/28486327/tourniquets-in-trauma-care-a-review-of-application
#1
Brian Cornelius, Ryan Campbell, Pat McGauly
Traumatic hemorrhage has been identified as the leading cause of battlefield death in recent conflicts. Although injury patterns are not directly reproducible to the civilian world, treatment advancements can be used to provide care to patients worldwide. Long-standing dogma regarding the use of tourniquets has been disproved, and there is now recognition of the critical role that tourniquets play in trauma care. The history and evolution of tourniquets, including the identification of previous faults in application, will lead to an examination of the current devices in use along with evidence-based recommendations for use...
May 2017: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
https://www.readbyqxmd.com/read/28482626/ten-minutes-of-ischemia-is-superior-to-shorter-intervals-for-the-remote-ischemic-conditioning-of-human-microcirculation
#2
J Kolbenschlag, A Sogorski, C Timmermann, K Harati, A Daigeler, T Hirsch, O Goertz, M Lehnhardt
BACKGROUND: Surgical flaps have become reliable tools in the microsurgical armamentarium, but are still faced with tissue loss due to impaired perfusion which can lead to complete flap failure. Remote Ischemic Conditioning (RIC) has been demonstrated to be an effective way to improve microcirculation in surgical flaps in humans. However, little is known about the optimal amount and length of RIC cycles. OBJECTIVE: Determination of a superior protocol for RIC of cutaneous microcirculation in humans...
May 5, 2017: Clinical Hemorheology and Microcirculation
https://www.readbyqxmd.com/read/28482625/transepidermal-oxygen-flux-during-arterial-occlusion-using-ratiometric-luminescence-imaging
#3
M Ranieri, S Klein, A Kotrade, C Taeger, J D Dolderer, L Prantl, S Geis
BACKGROUND: A physiological oxygen transport through a circulatory and microcirculatory system is essential for execution of cellular functions. Several pathological conditions e.g. infections, ischemia, cancer, diabetes, hypertension or chronic wounds show a change of oxygen distribution and oxygen tension in cellular microenvironment. Additionally complex operative procedures in order to reconstruct tissue defects require a reliable monitoring of microcirculation. OBJECTIVE: Target of this study was to evaluate skin oxygenation during an ischemia-reperfusion experiment using transepidermal oxygen flux imaging...
May 2, 2017: Clinical Hemorheology and Microcirculation
https://www.readbyqxmd.com/read/28475239/two-tourniquet-sequential-blocking-as-a-simple-intervention-for-hemorrhage-during-cesarean-delivery-for-placenta-previa-accreta
#4
Jin-Lai Meng, Wei-Yan Gong, Shan Wang, Xiao-Jing Ni, Chang-Ting Zuo, Yong-Zhong Gu
Placenta previa accreta (PPA) can result in severe obstetric hemorrhage, which usually necessitates hysterectomy. The median blood loss for placenta accreta has been reported to range from 2000 to 7800 mL [1]. It is a severe and life-threatening obstetric complication in most countries. The present article reports a conservative, simple method-the two-tourniquet sequential blocking technique-to control severe bleeding during cesarean delivery in the event of PPA. This article is protected by copyright. All rights reserved...
May 5, 2017: International Journal of Gynaecology and Obstetrics
https://www.readbyqxmd.com/read/28474993/de-novo-giant-posterior-cerebral-artery-aneurysm-developing-25-years-after-basilar-bifurcation-aneurysm-treatment-using-a-drake-tourniquet-case-report-and-implications-for-aneurysm-follow-up
#5
Rafael Martinez-Perez, David M Pelz, Stephen P Lownie
The objective of this paper was to report a rare complication of basilar artery (BA) tourniquet treatment of a giant basilar tip aneurysm, and to discuss possible causes for the formation of a de novo giant posterior cerebral artery (PCA) aneurysm. A 34-year-old woman underwent satisfactory treatment of a ruptured giant basilar bifurcation aneurysm by BA ligation (Drake tourniquet) in 1985. She presented 25 years later with a new aneurysm in the left PCA, successfully treated by coil embolization. To the authors' knowledge, this is the first case of de novo aneurysm formation on a PCA, and the first de novo aneurysm reported as a complication of BA ligation therapy by Drake tourniquet...
May 5, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28470576/a-comparative-analysis-of-the-role-of-tranexamic-acid-as-an-independent-variable-in-reducing-intraoperative-blood-loss-in-patients-undergoing-conventional-total-knee-arthroplasty-versus-computer-assisted-total-knee-arthroplasty
#6
K K Eachempati, A V Gurava Reddy, S Apsingi, S R Sankineani, J Shaheed, C Dannana
BACKGROUND: Blood loss in total knee arthroplasty (TKA) is an area of significant concern as it has an effect on patient morbidity and hospital stay. Among many different modalities to reduce blood loss, the use of Tranexamic acid has become a standard procedure nowadays. The aim of our study was to determine if Tranexamic acid alone decreases blood loss as an independent variable irrespective of other blood loss preserving measures. METHOD: This prospective non-randomized study included patients undergoing unilateral TKA by conventional method (Group 1) and computer-assisted TKA (Group 2)...
May 3, 2017: Musculoskeletal Surgery
https://www.readbyqxmd.com/read/28464968/prehospital-interventions-during-mass-casualty-events-in-afghanistan-a-case-analysis
#7
Steven G Schauer, Michael D April, Erica Simon, Joseph K Maddry, Robert Carter, Robert A Delorenzo
BACKGROUND: Mass-casualty (MASCAL) events are known to occur in the combat setting. There are very limited data at this time from the Joint Theater (Iraq and Afghanistan) wars specific to MASCAL events. The purpose of this report was to provide preliminary data for the development of prehospital planning and guidelines. METHODS: Cases were identified using the Department of Defense (DoD; Virginia USA) Trauma Registry (DoDTR) and the Prehospital Trauma Registry (PHTR)...
May 3, 2017: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/28462164/acute-foreskin-strangulation-injury-due-to-bathing-suit-mesh-entrapment
#8
Arvind Krishnan, Barrett McCormick, Hubert Swana, Mark Rich
Genital injury can occur at any age of life but is most common in the pediatric population. Hair-tourniquets and circumcision procedures are the most common causes of penile injury in children. Foreskin trauma, aside from zipper related injuries, is sparsely reported. We describe the case of an 8-year-old male who presented with foreskin entrapment caused by bathing suit mesh. Management and literature review are discussed.
July 2017: Urology Case Reports
https://www.readbyqxmd.com/read/28460426/effects-of-tourniquet-number-and-exsanguination-on-amikacin-concentrations-in-the-radiocarpal-and-distal-interphalangeal-joints-after-low-volume-intravenous-regional-limb-perfusion-in-horses
#9
Mike J Schoonover, Darla K Moser, Jenna M Young, Mark E Payton, Todd C Holbrook
OBJECTIVE: To determine the influence of a dual tourniquet technique and limb exsanguination on amikacin concentrations in the synovial fluid of the radiocarpal joint (RCJ) and distal interphalangeal joint (DIPJ) after low volume, cephalic intravenous regional limb perfusion (IVRLP). STUDY DESIGN: Randomized cross-over design. ANIMALS: Six healthy adult horses. METHODS: One gram of amikacin in 6 mL of 0.9% NaCl was infused via cephalic IVRLP in 6 standing, sedated horses using 4 techniques: proximal pneumatic tourniquet (P), proximal pneumatic tourniquet with exsanguination (PE), proximal pneumatic and distal Esmarch tourniquet (PD), and proximal pneumatic with distal Esmarch tourniquet and exsanguination (PDE)...
April 29, 2017: Veterinary Surgery: VS
https://www.readbyqxmd.com/read/28453349/chronic-exertional-compartment-syndrome-of-the-hand-case-report-and-literature-review
#10
C Liam Dwyer, Maximillian C Soong, N George Kasparyan
BACKGROUND: Chronic exertional compartment syndrome (CECS) is characterized by activity-induced pain, swelling, and decreased muscle function due to increased pressure and decreased circulation within a confined muscle compartment. Although well-known to occur in the leg, involvement of the hand has rarely been reported in the literature. METHODS: We present a 44 year old male with CECS involving bilateral thenar and hypothenar compartments. Symptoms were reproduced on exam by driving screws into wood with a screwdriver...
May 2017: Hand: Official Journal of the American Association for Hand Surgery
https://www.readbyqxmd.com/read/28450928/effect-of-etomidate-on-the-oxidative-stress-response-and-levels-of-inflammatory-factors-from-ischemia-reperfusion-injury-after-tibial-fracture-surgery
#11
Renke Li, Lei Fan, Fenglei Ma, Yongyan Cao, Junwei Gao, Huawen Liu, Yan Li
The effect of etomidate on the oxidative stress response and levels of inflammatory factors resulting from ischemia-reperfusion injury of the lower extremities during tibial fracture surgery were investigated. From December 2013 to June 2015, 60 tibial fracture patients with surgical indications for open reduction and internal fixation were selected. Patients were randomly divided into the observation group and the control group. All patients were stanched by tourniquet hemostasis. Patients in the observation group were anesthetized with etomidate (3-6 mg/kg·h) + remifentanil (0...
March 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28449627/lornoxicam-use-to-reduce-the-pain-associated-with-propofol-injection
#12
Nihal Başak, Yakup Aksoy, Ayhan Kaydu, Ömer Fatih Şahin
AIM: To investigate the efficacy of lornoxicam in the prevention of the pain associated with propofol injection. MATERIAL AND METHOD: Approval for this study was granted by the ethics committee of our hospital. Using a computer randomisation software, 120 patients undergoing elective surgery were assigned to four equal groups. In Group I (control group), immediately before anaesthesia induction, 10 ml of isotonic 0.9% NaCl solution (placebo) was administered intravenously (IV)...
December 2017: Libyan Journal of Medicine
https://www.readbyqxmd.com/read/28446350/the-first-aid-and-hospital-treatment-of-gunshot-and-blast-injuries
#13
Axel Franke, Dan Bieler, Benedikt Friemert, Robert Schwab, Erwin Kollig, Christoph Güsgen
BACKGROUND: When gunshot and blast injuries affect only a single person, first aid can always be delivered in conformity with the relevant guidelines. In contrast, when there is a dynamic casualty situation affecting many persons, such as after a terrorist attack, treatment may need to be focused on immediately life-threatening complications. METHODS: This review is based on pertinent publications retrieved by a selective search in Medline and on the authors' clinical experience...
April 7, 2017: Deutsches Ärzteblatt International
https://www.readbyqxmd.com/read/28445317/timing-of-tourniquet-release-in-total-knee-arthroplasty-a-meta-analysis
#14
Pei Zhang, Yuan Liang, Jinshan He, Yongchao Fang, Pengtao Chen, Jingcheng Wang
BACKGROUND: For total knee arthroplasty (TKA), the tourniquet is routinely employed for better visualization, less blood loss, and easier cementation. However, the time to release tourniquet remains controversial. Therefore, we performed current meta-analysis to assess whether releasing tourniquet before wound closure is more effective in reducing blood loss than releasing tourniquet after wound closure in TKA without an increased risk of complications. METHODS: To conduct this meta-analysis, we searched Medline, Embase, Web of science, and the Cochrane library up to November 2016, for randomized controlled trials comparing tourniquet releasing before and after wound closure in TKA...
April 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28433364/belts-evaluated-as-limb-tourniquets-belt-study-comparing-trouser-supporters-used-as-medical-devices-in-a-manikin-model-of-wound-bleeding
#15
Blake W Bequette, John F Kragh, James K Aden, Michael A Dubick
OBJECTIVE: The purpose of the present study is to compare several models of commercially designed belts as used as a tourniquet. METHODS: In the Belts Evaluated as Limb Tourniquets (BELT) study, an experiment was designed to test the effectiveness of pants belts as nonimprovised medical devices to control hemorrhage in a manikin. Models of belts included Tourni-belt, Tourniquet Belt, ParaBelt, and Battle Buddy. Data collected included effectiveness, time to stop bleeding, total time of application, pressure, blood loss, and composite results (score count of good results; composite outcome good if every component was good)...
April 19, 2017: Wilderness & Environmental Medicine
https://www.readbyqxmd.com/read/28428919/tibial-bone-grafting-for-wrist-reconstruction
#16
Schneider K Rancy, Stephanie D Malliaris, Scott W Wolfe
Background Iliac crest bone graft harvesting is routinely performed for upper extremity orthopedic procedures despite high complication rates associated with sensory nerve injury, hematoma, chronic pain, and fracture. Description of Technique Cancellous bone graft is harvested from the proximal tibia using a medial approach, minimizing donor site morbidity. Patients and Methods A retrospective review was undertaken of 14 patients who underwent cancellous proximal tibia bone graft harvesting to augment healing of wrist reconstruction, with 2 months minimum follow-up...
May 2017: Journal of Wrist Surgery
https://www.readbyqxmd.com/read/28428759/morphological-regeneration-and-functional-recovery-of-neuromuscular-junctions-after-tourniquet-induced-injuries-in-mouse-hindlimb
#17
Huiyin Tu, Dongze Zhang, Ryan M Corrick, Robert L Muelleman, Michael C Wadman, Yu-Long Li
Tourniquet application and its subsequent release cause serious injuries to the skeletal muscle, nerve, and neuromuscular junction (NMJ) due to mechanical compression and ischemia-reperfusion (IR). Monitoring structural and functional repair of the NMJ, nerve, and skeletal muscle after tourniquet-induced injuries is beneficial in exploring potential cellular and molecular mechanisms responsible for tourniquet-induced injuries, and for establishing effective therapeutic interventions. Here, we observed long-term morphological and functional changes of the NMJ in a murine model of tourniquet-induced hindlimb injuries...
2017: Frontiers in Physiology
https://www.readbyqxmd.com/read/28417223/dorsal-metacarpal-veins-anatomic-variation-and-potential-clinical-implications
#18
Sara S Elmegarhi, Justin Z Amarin, Maher T Hadidi, Darwish H Badran, Islam M Massad, Amjad M Bani-Hani, Amjad T Shatarat
The dorsal metacarpal veins are frequently cannulated. Cannulation success is determined by several variable anatomic features. The objective of this study is to classify, for the first time, the anatomic variants of the dorsal metacarpal veins. In this cross-sectional study, 520 university students and staff were conveniently recruited. The dorsal metacarpal veins in 1040 hands were studied. Venous visibility was enhanced by either tourniquet application or near-infrared illumination. Variant patterns of the dorsal metacarpal veins were classified...
April 17, 2017: Anatomical Science International
https://www.readbyqxmd.com/read/28413903/digital-revascularization-and-replantation-using-the-wide-awake-hand-surgery-technique
#19
Jkf Wong, C H Lin, N J Chang, H C Chen, Y T Lin, C C Hsu
The use of local anaesthesia and adrenaline for hand surgery is gaining popularity; however, where vascularity is impaired, wide-awake surgery is considered a contraindication. We present our case series of five digital devascularizations and eight amputations that underwent surgery using the 'wide-awake' anaesthetic technique. A temporary digital tourniquet (< 20 min) was used in three cases to identify structures quickly. The anastomoses were performed under local anaesthesia without a tourniquet. All cases had successful re-establishment of blood flow with good perfusion to the digital tips; no cases were re-explored because of vascular crisis...
April 1, 2017: Journal of Hand Surgery, European Volume
https://www.readbyqxmd.com/read/28411931/north-american-snake-envenomation
#20
REVIEW
Bryan Corbett, Richard F Clark
Native US snakes that produce clinically significant envenomation can be divided into 2 groups, crotalids and elapids. The crotalids include rattlesnakes, cottonmouths, and copperheads. Crotalid envenomation can result in significant local tissue damage as well as thrombocytopenia and coagulopathy. Rarely are bites fatal. Native US elapids are all coral snakes that possess neurotoxic venom that can cause weakness, respiratory paralysis, and rarely death. Treatment of both types of envenomation revolves around general supportive care and antivenom administration when indicated...
May 2017: Emergency Medicine Clinics of North America
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