...Draft of Intern’s Project Penetrating Abdominal Injuries at Georgetown Public Hospital Corporation (GPHC). Investigator: Hemraj Ramcharran Supervisors: Dr Shilendra Rajkumar Dr Madan Rambaran Abstract Many cases of penetrating abdominal injuries present to the Georgetown Public Hospital all of which are managed by the department of Surgery. No audit has been conducted on the management of these injuries and their success rates. Hence this prospective study “Penetrating abdominal Injuries at Georgetown Public Hospital (GPHC)” seeks to shed some light in these areas in terms of percentage of abdominal injuries managed surgically or conservatively and diagnostic adjuncts used in the management of these patients. Studies done in other countries clearly show that there is a steady and progressive movement away from surgical management of penetrating abdominal wounds towards conservative management. The study is a prospective one that will extend over the period (April 01 – Sept 31). The study population will consist of persons over 12 years old and admitted for penetrating abdominal injury. Data will be collected by means of a form shown in appendix 2. This form has three parts which are biodata, immediate management and subsequent management. These forms will be in the accident and emergency room and the surgical wards. On admission of the patient, the on call surgical GMO or Intern will fill out the...
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...Ocular trauma is a significant cause of visual loss in young populations, especially in males. There are 2.4 million ocular injuries occur in the United States every year and over 57% of them are below age 30.5,6 Accidental ocular injuries requiring treatment are four times more likely to happen to boys than girls. Ocular trauma can be either be closed-globe or penetrating and roughly 35% of these injuries result in permanent visual impairment.7 Penetrating ocular trauma is typically caused by projectile emitted from a metal-on-metal strike, BB gun or pellet rifle.7 Non-penetrating trauma are frequently happened during the working hours by deflection, and by neglecting safety glasses.9 Possible sequelae associated with both closed-globe...
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...contamination requiring washout and repair of a hollow viscus? Penetrating injuries with any hemodynamic instability and/or signs of intraperitoneal injury are treated operatively at the outset of 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...
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...more relevant than ever to stress the type of eye injuries that can happen while practicing a sport and the best way to protect ourselves.Whether it’s basketball , football, baseball or any type of sports humans in general , are more exposed than ever to eye injuries . Along the same side, according to the book sport vision care for the enhancement of sports performance “ sports - related ocular injuries account for 33000 to 100000 of the estimated 2.4 million eye injuries that occur in the US annually”...
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...them, how effective is the use in preventing fatalities? With minimal historic research available, federal agencies have begun to study this issue. A collaboration of numerous experts in science, ballistics and law enforcement have compiled information to rate the effectiveness of modern body armor. This rating system identifies the potential protection of the six different body armor levels currently in use in the United States. Utilizing statistical information maintained by the Federal Bureau of Investigation, concerning officers who were shot in the line of duty, findings reveal that wearing body armor does save lives. Some injuries (non-life threatening backface signature wounds) still occur due to the impact of the projectile with the body armor and some fatalities occur due to a round escaping the protective fibers by slant deflection. Currently, there is no singular bullet proof material for use by police officers, the body armor in use today has and will continue to save the lives of those who wear the badge. The unpredictable nature of policing in today’s society brings to light concerns about what can be done to increase officer safety. The murder of a law enforcement officer has a horrific effect not only on the officer’s family and friends, but on their law enforcement agency and the entire community. In many cases, at the very instant an officer is shot, he or she is attempting to protect the community from those who would cause chaos and harm...
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...deadly. Although Tasers aren’t designed to cause serious bodily injury, they...
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...Traumatic Brain Injury WUT2 Task Western Governors University A. Investigated Disease Process The disease process I will be reviewing is traumatic brain injuries. A traumatic brain injury occurs when sudden trauma occurs to an individual’s brain. Traumatic brain injuries are considered closed or penetrating. Traumatic brain injuries are categorized as mild, moderate or severe based on the amount of damage that occurs to the brain. (ninds.nih.gov, 2015) A1. Pathophysiology To understand traumatic brain injuries, we must first discuss the numerous causes of brain injury. When injury occurs to the brain, the patient encounters the primary injury that is directly related and occurs at the time of the injury. Secondary injury occurs as a result of the primary injury but often leads to a more significant sequela based on the type of initial trauma. Non penetrating injuries to the cranium that lead to traumatic brain injuries are not always related to direct blows of the cranium. Rapid acceleration and deceleration injuries along with compression injuries may lead to traumatic brain injuries. This type of injuries can lead to injuries to the brain tissue that could include compression, stretching and shearing injuries to the brain tissue. These type of injuries are classified as “diffuse axonal injuries”. Diffuse axonal injuries are one of the most common and extensive types of traumatic brain injuries. These injuries often lead to death or severe irreversible...
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...this question. Brain imaging like MRI’s, CAT, and PET scans all help in discovering the brains role in cognitive functioning. Advances in imaging technology have helped researchers pin point which areas of the brain are responsible for thinking, learning and memory. By recording activity of the brain in action, researchers can examine the systems of brain regions that participate in different cognitive functions, ranging from basic sensory and motor functions to complex functions like reasoning and language understanding. According to the Center for Neural Basis of Cognition (CNBC) at the University of Pittsburg “To discover how brain cells actually support cognitive processes, CNBC investigators use physiological studies of neuronal activity in animals. Such studies have uncovered neurons that encode basic sensory properties of stimuli as well as others that reflect deeper cognitive analyses, such as the relative location of one object with respect to other objects of interest, the emotional content of a facial expression, the location of the animal in extra personal space or the anticipated reward value...
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...Buccal squamous cell carcinoma is an aggressive form of oral carcinoma with a high recurrence rate1. Iatrogenic parotid duct injury is often unavoidable when surgically treating buccal squamous cell carcinoma due to the intimate anatomic relationship between the buccal mucosa, Stensen’s duct and the parotid gland. It is often difficult to achieve negative margins and preserve the integrity of the parotid duct.2. Sialocele formation is a frequent and untoward complication due to extravasation of saliva into the surgical defect which delays healing, creates fistulas and produces painful facial swelling. Currently, no consensus exists regarding the management of a parotid sialocele.3 Multiple authors have described varying modalities of treatment...
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...Kileigh Keller Case Report 4 Eyes and Face Rhegmatogenous Retinal Detachment Objective: The objective of this case is to treat the complications of Rhegmatogenous Retinal Detachment in the right eye. Background: A 62-year-old female with no history of eye complications that was diagnosed with Rhegmatogenous Retinal Detachment in the right eye after a traumatic fall. Differential Diagnosis: Retinal Tear, Tractional retinal detachment, In exudative detachment Treatment: Scleral buckling surgery to fix the detachment. Uniqueness: No history of eye problems. The detachment happened after a traumatic fall. The individual also suffered from a humerus fracture and a serve concussion. Conclusion: Most Rhegmatogenous Retinal Detachment’s do not happen from traumatic events. The patient did not have symptoms of the detachment until a month after the fall. The concussion was diagnosed but no other tests were done for the individuals’ eyes. Those should have been checked to prevent the medical emergency. Body: A rhegmatogenous retinal detachment occurs due to a break in the retina that allows fluid to pass from the vitreous space into the subretinal space between the sensory retina and the retinal pigment epithelium.3 A minority of retinal detachments result from trauma, including blunt blows to the orbit, penetrating trauma, and concussions to the head. A retrospective Indian study of more than 500 cases of rhegmatogenous detachments found that 11% were...
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...In this paper, traumatic brain injuries, the effects on speech and language, and the speech-language pathologist’s role with patients who have suffered a traumatic brain injury will be discussed. A traumatic brain injury is a very common cause of speech and language problems. It is an acquired cause, meaning it is not present at birth. It affects many areas of communication, including cognitive and memory skills, as well as speech and language. A speech-language pathologist plays an important role in these individuals’ lives. Speech-language pathologists are responsible for both the evaluation and the therapy for the patient. TRAUMATIC BRAIN INJURY Introduction Numerous research studies have been conducted on the topic...
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...Diagnosing and reporting child abuse EHC1103 - Medical Ethics 06/02/2013 Introduction When people make a decision to have children, the universal plan is for the parents to love and cherish them. However, unluckily this is not always the result. There are adults in this world who abuse children whether they are infants or teenagers. The National Child Abuse and Neglect Data System (NCANDS), maintained by the U.S. Department of Health and Human Services provide information that younger children are more prevalent to child abuse than older children is and that the abusers are the parents or relatives. I am interested in the topic child abuse because I am a mother of two and the Media reveal so much of child abuse and neglect that people are unaware of how children are to be protected and not neglected. Children are a precursor to adulthood and if we as adults do not protect their innocents then who will? Once a child has been a victim of abuse, they are capable of occurring Social anxiety disorder (SAD). Although often not diagnosed until many years after the symptom onset, SAD onsets early in life, typically by early adolescence, and thus commonly characterized by chronic associated distress and dysfunction (Depression and Anxiety26:1027-1032(2009),Childhood maltreatment linked to greater symptom severity...
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...Diagnosing and reporting child abuse EHC1103 - Medical Ethics 06/02/2013 Introduction When people make a decision to have children, the universal plan is for the parents to love and cherish them. However, unluckily this is not always the result. There are adults in this world who abuse children whether they are infants or teenagers. The National Child Abuse and Neglect Data System (NCANDS), maintained by the U.S. Department of Health and Human Services provide information that younger children are more prevalent to child abuse than older children is and that the abusers are the parents or relatives. I am interested in the topic child abuse because I am a mother of two and the Media reveal so much of child abuse and neglect that people are unaware of how children are to be protected and not neglected. Children are a precursor to adulthood and if we as adults do not protect their innocents then who will? Once a child has been a victim of abuse, they are capable of occurring Social anxiety disorder (SAD). Although often not diagnosed until many years after the symptom onset, SAD onsets early in life, typically by early adolescence, and thus commonly characterized by chronic associated distress and dysfunction (Depression and Anxiety26:1027-1032(2009),Childhood maltreatment linked to greater symptom severity...
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...work. I thank them for all their support, help, interest and valuable hints. Last but not least, I would like to thank my family especially my husband whose patient love enable me to complete this work. Table of Content | | |Page No. | |1. |Introduction |1 – 2 | |2. |Clinical Assessment |3 – 6 | |3. |Management Related To Head Injury |7 - 8 | |4. |Immediate Care And Management Of Patient |9 - 12 | |5. |Conclusion |12 | |6. |Appendixs |13 - 14 | |6. |References |15 - 16...
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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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