February 16th, 2006
“Privacy Reasons” Keeping Cheney Shooting Victim in ICU?
As stated in yesterday’s Tip of the Day the editors of this site do not have any direct patient care of Harry Whittington, who was shot by Vice-President Dick Cheney on February 12 in a hunting accident. Today, the news reports stated that the patient was being kept in the intensive care unit only for “privacy reasons” and not because of his condition.
However, boarding patients in the ICU who don’t need to be there for their medical condition has
Continue reading "“Privacy Reasons” Keeping Cheney Shooting Victim in ICU??"
February 14th, 2006
Although the editors of this site not are not providing care to Harry Whittington, who was shot by Vice-President Dick Cheney on February 12, 2006, there appear to be some puzzling questions that remain unanswered about what happened to the patient after he was taken to the hospital.
Birdshot wounds are a common hunting injury seen by trauma surgeons. The injury is caused by
Continue reading "Heart Condition of Cheney Shooting Victim a Puzzle"
February 13th, 2006
Radiation Recall Reactions
Radiation therapy is being used ever more frequently in ongoing assault against cancer. Some of the cancers treated in part with radiation therapy are breast cancer, rectal cancer, ovarian and endometrial cancer, brain cancer, and head and neck cancers. Generally, the treatment is well-tolerated by patients who may report some fatigue and nausea.
One unusual but striking complication of radiation therapy is radiaton recall reaction. This is the development of severe erythema and desquamation of the skin (shedding of the skin) that develops in the area of the radiation field, sometimes years after the radiation was given. It can be triggered by chemotherapeutic agents like doxorubicin (adriamycin) or some antibiotics in the fluoroquinolone group such as gatifloxacin (Levaquin). It can be painful and is usually very disturbing to the patient, but it typically resolves if the eliciting agent is stopped.
Copyright 2006 Surgeryandyou.com
February 13th, 2006
C-Reactive Protein and Your Arteries
Do you know your C-reactive protein value? If you don’t, some doctors are now recommending that you get the simple blood test that can tell you if this elevated so you can take steps to reduce it if need be.
Although doctors are still figuring out exactly what the relationship of CRP is to cardiovascular disease, it is clear that if this protein appears in your blood it is a sign of inflammation of the arteries. And inflammation of all types is being found to contribute to a host of medical problems, from heart attack and stroke to diabetes and cancer.
Copyright 2006 Surgeryandyou.com
February 11th, 2006
What happened to Ariel Sharon?
Although none of the editors of this website have any direct clinical care of Ariel Sharon, his situation is sadly all too familiar to most surgeons. News services are relating that he had about 20 inches of his colon removed today and very likely a colostomy after a CT scan showed “disease”. What happened?
Most likely the CT scan showed one of three things that tipped surgeons off to a problem:
1) “free air” in the abdominal cavity indicating a perforated structure as the abdominal cavity normally has no air; it is all inside the bowel.
2) air in the wall of the intestine (the technical term is pneumotosis intestinalis); again this is abnormal and highly suggestive of dead or ischemic bowel.
3) greatly enlarged loops of bowel; this occurs when the colon twists on itself (the technical term is volvulus).
Other indications that surgeons use when trying to figure out if the bowel is diseased are a new fever, a lower pH, an increased weight blood cell count, an increased level of lactate, and hypotension.
Copyright 2006 Surgeryandyou.com
February 10th, 2006
Acupressure and Needle Sticks
Let’s face it – needle sticks can hurt. One strategy some doctors use to lessen the pain of a needle being inserted into the skin for a blood draw, injection of local anesthesia, or an intravenous line is acupressure. This technique is performed by direct, firm pressure for twenty seconds with the fingertip at the site the needle is going to be inserted. This “floods” the pain fibers leading from the skin to the brain and deadens the sensation for subsequent stimuli.
Copyright 2006 Insidesurgery.com
February 10th, 2006
Her-2/neu and Breast Cancer
This is the shorthand name for human epidermal growth factor receptor and is also known as c-erbB-2. The presence of this protein receptor is associated with a worse prognosis in breast cancer. There are several different tests used to detect the presence of this protein but the usual method is to sample the tumor directly or to take a blood sample.
Approximately 10%-35% of breast cancers are positive for this protein. Herceptin is commonly used to treat patients who are postive for her-2/neu but for reasons not understood only about 35% of patients respond to Herceptin.
Copyright 2006 Insidesurgery.com
February 8th, 2006
Viagra and Nitrates
Viagra (sildenafil) was the first oral medication approved by the Food and Drug Administration for treatment of erectile dysfunction or impotence. It works by dilating the veins that lead to an erection by enhancing the effects of nitric oxide, a substance in the body that causes the blood pressure to decrease.
Erectile dysfunction is common in men with coronary or cardiovascular disease and this combination provides the setting for a dangerous drug interaction. Topical, oral, or sublingual nitrates such as nitroglycerin or isosorbide are taken for angina or chest pain and also cause a drop in blood pressure. When taken together there is usually a marked decrease in systemic blood pressure and the possibility of dangerous heart rhythms. In the surgical vernacular this is described as “a synergistic vasodilation causing profound hypotension and the onset of malignant arrhythmias.”
Copyright 2006 Insidesurgery.com
February 7th, 2006
Acute Blood Loss
The best fluid to treat shock in acute blood loss is fresh whole blood, which simply replaces the same things that are lost in acute blood loss or hemorrhage. It is rarely available because it has a short storage life.
Typically, acute blood loss is treated by replacing the individual major components of blood. These are packed red blood cells that perform oxygen transport, platelets that initially plug the bleeding, fresh frozen plasma that contains many of the needed coagulation factors, and cryoprecipitate that contains the remaining coagulation factors.
In “surgicalese” these components are referred to as PRBC’s, platelets, FFP, and cryo.
Copyright 2006 Insidesurgery.com
February 6th, 2006
Posttraumatic Pulmonary Pseudocyst
What the heck is this!?
This is a condition that occurs in the lungs after blunt trauma to the chest. Though it is unusual, it must be watched for in all adults who undergo this type of injury. It develops during the first week and is seen on chest radiograph as a fluid or air-filled cavity in the lung tissue. These lesions become life-threatening if they become infected.
Unfortunately, simply giving antibiotics usually is not an effective treatment. Infected pseudocysts with just one cavity should be drained by having the radiologists place and leave a drain through the skin. Pseudocysts with more than one cavity usually require an operation that may result in one of the lobes of the lung being removed.
Or, in the vernaculuar of surgeons – simple pseudocysts require percutaneous drainage and loculated pseudocysts require thoracotomy leading to lobectomy most typically.
Copyright 2006 Insidesurgery.com
February 5th, 2006
Diuretics and Cholesterol Levels
It is very common for surgical patients to receive diuretics (for example Lasix or furesomide) to remove excess fluid after surgery. Over the short period (a few days) there is not much effect on lipid metabolism. However, if used longer term Lasix can result in increased levels of total cholesterol, low density lipoprotein (the “bad cholesterol”), very-low density lipoprotein (the “very bad cholesterol”), and triglycerides.
Copyright 2006 Insidesurgery.com
February 4th, 2006
Doll’s Eyes Reflex in Brain Trauma
When attempting to determine brain death, there are many clinical and radiological tests that surgeons and neurosurgeons use. One of the most reliable is the doll’s eyes or oculocephalic reflex. This test screens for activity in the brain stem areas of the midbrain, pons, and medulla, which are responsible for basic activities like breathing or respiration.
The test is performed by suddenly turning the patient’s head and recording what the eyes do. In patients with brainstem injury and in patients who are awake and conscious, when the head is suddenly turned the eyes move in synchrony with it. In patients who are not conscious but whose brainstem is uninjured, the eyes lag behind similar to a doll’s eyes when the head is suddenly turned.
This maneuver can only be tried in patients who have been ruled out for cervical spine injuries.
Copyright 2006 Insidesurgery.com
February 3rd, 2006
Blunt Trauma and CT Reconstructions of the Spine
The spine is a commonly injured area of the body in blunt trauma from falls, motor vehichle accidents, and sporting accidents. These injuries are associated with spinal cord injuries. All states have regulations governing how the emergency medical technicians handle patients to prevent a spine fracture or dislocation from causing or worsening a neurological injury.
Once the EMT’s get the patient to the trauma center, all patients are evaluated for the likelihood of a spine injury. In order to rule this out, almost all trauma centers and many emergency rooms use the new generation of CT (computed tomography) scanners that can quickly scan the patient and give a 3-dimensional view of the entire spine, including the cervical, thoracic, lumbar, and sacral portions. In the vernacular of the trauma business these radiology studies are called the “C, T, and L spine recons” and they are much better at picking up small fractures and injuries than the old plain x-rays that were taken until a few years ago.
Copyright 2006 Surgeryandyou.com
February 2nd, 2006
Penetrating Trauma
Although trauma surgery is a relatively new discipline in surgery, trauma injuries are not. They are the leading cause of death among young people in the United States. Trauma injuries are classified as either blunt (motor vehichle crash, assault with a baseball bat) or penetrating (gunshot wound, stab wound, embedded object).
Most trauma surgeons recommend that any object that has caused a penetrating wound NOT be removed before the patient is in the operating room with trained professionals. This is because as horrific as the injury appears to be with a knife protruding from the chest wall, it is possible that the knife is blocking further bleeding that can be unleashed in a life-threatening hemorrhage if it is removed. In fact, even trained trauma surgeons do not remove penetrating objects until they are in a position to control and replace this expected bleeding if it should occur.
February 1st, 2006
Basal Rates in Patient Controlled Analgesia
The use of patient controlled analgesia (PCA) machines was a true advance in the care of postoperative patients. These machines allow the patient to give themselves doses of a narcotic when they are experiencing pain. The most common narcotics given out in PCA machines are morphine and fentanyl. The machines have a preset limit
Continue reading "February 1, 2006"
|
