Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.551
Filtrar
1.
Medicine (Baltimore) ; 99(35): e21975, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871947

RESUMO

To investigate the efficiency of high ligation, great saphenous vein stripping and subfascial perforator vein surgery for treating great saphenous vein varicosis under the assistance of sterilized electric pneumatic tourniquet and Esmarchs bandage.In total, 274 patients confirmed with primary varicosis between January 2014 and November 2017 were included in this study. Patients were divided intoAfter surgery, the affected limbs in both groups were wrapped up using the elastic bandage for 2 weeks, followed by wearing elastic stocking for 6 months. Then we analyzed the intraoperative bleeding, surgery time, subcutaneous hemorrhage after surgery and postoperative pains.The surgical time in the treatment group was significantly lower than that of control group (58.62 ±â€Š7.47 minutes vs 76.35 ±â€Š9.24 minutes, P < .01). The intraoperative bleeding in the treatment group was significantly lower than that of the control group (17.56 ±â€Š3.52 ml vs 49.87 ±â€Š8.78 ml, P < .01).High ligation, great saphenous vein stripping, and subfascial perforator vein surgery under the assistance of sterilized electric pneumatic tourniquet and Esmarch's bandage was effective for the treatment of varicosis in lower limbs featured by reduced surgery time and less bleeding.


Assuntos
Veia Safena/cirurgia , Torniquetes , Varizes/cirurgia , Procedimentos Cirúrgicos Vasculares/instrumentação , Adulto , Idoso , Feminino , Humanos , Ligadura , Masculino , Pessoa de Meia-Idade
2.
Wiad Lek ; 73(7): 1330-1333, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32759414

RESUMO

OBJECTIVE: The aim: to find out the effect of a two-hour tourniquets ischemia of the limb and acute blood loss on systemic disorders of the body in the postperfusion period. PATIENTS AND METHODS: Materials and methods: The experiments were performed on 96 nonlinear male rats weighing 200-220 g. All experiments were performed under sodium thiopental anesthesia. In the first experimental group, two-hour tourniquets limb ischemia was simulated. In the second experimental group, acute blood loss was modeled. In the third experimental group, these lesions were combined. In 1 and 2 hours, as well as in 1, 7 and 14 days, the biliary function of the liver was determined in the experimental animals. RESULTS: Results: Two-hour tourniquets ischemia of the limb in the reperfusion period compared with the control was accompanied by a significant decrease in the rate of bile excretion, which reached a minimum value in 3 h - 1 day of the experiment and returned to the control level in 14 days. After the simulation of acute blood loss, the rate disturbance of bile excretion became significantly greater in all observation periods. The complication of acute ischemia-limb reperfusion caused a greater decrease in the rate of bile excretion with a maximum in 1 day of the experiment. Under these conditions, at 1, 7, and 14 days, the indicator was statistically significantly lower than in the other study groups. CONCLUSION: Conclusions: In the case of acute blood loss, complicated by two-hour tourniquets ischemia of the limb, the reperfusion period is accompanied by a summation of the negative impact of blood loss, ischemia and reperfusion of the limb on the functional state of the liver, which is a significant decrease in the rate of bile excretion with a maximum in 1 day, which further increases, but up to 14 days does not reach the level of control.


Assuntos
Isquemia , Traumatismo por Reperfusão , Torniquetes , Animais , Hemorragia , Fígado , Masculino , Ratos
3.
J Spec Oper Med ; 20(2): 76-82, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32573742

RESUMO

BACKGROUND: We sought new knowledge by further developing a model of using calculations in the simulation of a first-aid task. The purpose of this study was to develop the model to investigate the performance of tourniquet use in its component steps. METHODS: We aimed to design an experiment on a desktop computer by mathematically manipulating simulated data in tourniquet use. A time factor of tourniquet use was ranged widely through time challenges in five degrees from ideal to worst performances. Redesigning the task was assessed by time costs and blood losses. RESULTS: The step of tourniquet application took 17% of the trial time and securing the tourniquet after bleeding control took the longest amount of the trial time, 31%. A minority of the time (48% [17% + 31%] to apply tourniquet plus secure it) was spent after the tourniquet touched the patient, whereas most of the time (52%) was spent before the tourniquet touched the patient. The step of tourniquet application lost 14% of the total blood lost, whereas no blood was lost during securing the tourniquet, because that was the moment of bleeding control despite securing the tourniquet taking much time (31%). Most (86%) of blood lost occurred before the tourniquet touched the patient. But blood losses differed 10-fold, with a maximum of 2,434mL, which, when added to a pretask indication blood loss of 177mL, summed to 2,611mL. Before redesigning the task, costs of donning gloves and calling 9-1-1 included uncontrolled bleeding, but gloving mitigated risk of spreading pathogens among people. By step and person, redesigns of the task altered the risk-benefit profile. CONCLUSIONS: The model was useful because it simulated where most of the bleeding occurred before the tourniquet touched the patient. Modeling simulated redesigns of the task, which showed changes in the task's risk-benefit profile by step and among persons. The model generated hypotheses for future research, including the capability to screen candidate ideas among task designs.


Assuntos
Primeiros Socorros , Hemorragia/terapia , Torniquetes , Simulação por Computador , Humanos , Fatores de Tempo
4.
J Spec Oper Med ; 20(2): 83-94, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32573743

RESUMO

BACKGROUND: Sometimes tourniquets are applied over clothing. This study explored clothing effects on pressures and application process. METHODS: Generation 7 Combat Application Tourniquets (C-A-T7), Generation 3 SOF® Tactical Tourniquets-Wide (SOFTTW), Tactical Ratcheting Medical Tourniquets (Tac RMT), and Stretch Wrap And Tuck Tourniquets (SWATT) were used with different clothing conditions (Bare, Scrubs, Uniform, Tights) mid-thigh and on models (ballistic gel and yoga mats). RESULTS: Clothing affected pressure responses to controlled force applications (weight hangs, n=5 thighs and models, nonlinear curve fitting, p < .05). On models, clothing affected secured pressures by altering surface interactions (medians: Gel Bare C-A-T7 247mmHg, SOFTTW 99mmHg, Tac RMT 101mmHg versus Gel Clothing C-A-T7 331mmHg, SOFTTW 170mmHg, Tac RMT 148mmHg; Mats Bare C-A-T7 246mmHg, SOFTTW 121mmHg, Tac RMT 99mmHg versus Mats Clothing C-A-T7 278mmHg, SOFTTW 145mmHg, Tac RMT 138mmHg). On thighs, clothing did not significantly influence secured pressures (n=15 kneeling appliers, n=15 standing appliers) or occlusion and completion pressures (n=15). Eleven of 15 appliers reported securing on clothing as most difficult. Fourteen of 15 reported complete applications on clothing as most difficult. CONCLUSIONS: Clothing will not necessarily affect tourniquet pressures. Surface to tourniquet interactions affect the ease of strap sliding, so concern should still exist as to whether applications over clothing are dislodged in a distal direction more easily than applications on skin.


Assuntos
Vestuário , Coxa da Perna , Torniquetes , Humanos , Pressão
5.
J Spec Oper Med ; 20(2): 20-21, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32573738
6.
J Spec Oper Med ; 20(2): 110-114, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32573746

RESUMO

INTRODUCTION: Abdominal-pelvic hemorrhage (i.e., originates below the diaphragm and above the inguinal ligaments) is a major cause of death. It has diverse etiology but is typically associated with gunshot or stab wounds, high force or velocity blunt trauma, aortic rupture, and peripartum bleeds. Because there are few immediately deployable, temporizing measures, and the standard approaches such as direct pressure, hemostatics, and tourniquets are less reliable than they are with compressible extremity injuries, risk for death resulting from abdominal-pelvic hemorrhage is high. This review concerns the exciting potential of proximal external aortic compression (PEAC) as a temporizing technique for life-threatening lower abdominal-pelvic hemorrhage. PEAC can be accomplished by means of a device, two locked arms (manual), or a single knee (genicular) to press over the midline supra-umbilical abdomen. The goal is to compress the descending aorta and slow or halt downstream hemorrhage while not delaying more definitive measures such as hemostatic packing, tourniquets, endovascular balloons, and ultimately operative repair. METHODS: Clinical review of the Ovid MEDLINE, In-Process, & Other Non-Indexed, and Google Scholar databases was performed for the period ranging from 1946 to 3 May 2019 for studies that included the following search terms: [proximal] external aortic compression OR vena cava compression AND (abdomen or pelvis) OR (hemorrhage) OR (emergency or trauma). In addition, references from included studies were assessed. CONCLUSION: Sixteen studies met the inclusion criteria. Evidence was grouped and summarized from the specialties of trauma, aortic surgery, and obstetrics to help prehospital responders and guide much-needed additional research, with the goal of decreasing the high risk for death after life-threatening abdominal-pelvic hemorrhage.


Assuntos
Traumatismos Abdominais/terapia , Hemorragia/terapia , Pelve/lesões , Humanos , Pressão , Torniquetes
7.
J Spec Oper Med ; 20(2): 116-122, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32573747

RESUMO

The American College of Surgeons' "Stop the Bleed" (STB) campaign emphasizes how to apply the Combat Application Tourniquet (CAT), a device adopted by the military to control extremity hemorrhage. However, multiple commercially available alternatives to the CAT exist, and it would be helpful for instructors to be knowledgeable about how these other models compare. A PubMed search from January 2012 to January 2020 cross-referenced with a Google search for "tourniquet" was performed for commercially available tourniquets that had been trialed against the CAT. Windlass-type models included the Special Operations Forces Tactical Tourniquet (SOFT-T), the SOFT-T Wide (SOFFT-W), the SAM-XT tourniquet, the Military Emergency Tourniquet (MET), and the Tactical Medical Tourniquet (TMT). Elastic-type tourniquets included were the Stretch, Wrap, And Tuck Tourniquet (SWAT-T), the Israeli Silicone Tourniquet (IST), and the Rapid Activation Tourniquet System (RATS). Ratchet-type tourniquets included were the Ratcheting Medical Tourniquet (RMT) and TX2/TX3 tourniquets, and pneumatic-type tourniquets were the Emergency and Military Tourniquet (EMT) and Tactical Pneumatic Tourniquet (TPT). This review aims to describe the literature surrounding these models so that instructors can help laypeople make more informed purchases, stop the bleed, and save a life.


Assuntos
Primeiros Socorros , Hemorragia/terapia , Torniquetes , Humanos
8.
J Spec Oper Med ; 20(2): 22-23, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32573739
9.
Rev Lat Am Enfermagem ; 28: e3251, 2020.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-32321042

RESUMO

OBJECTIVE: to construct and validate a tool for the evaluation of responders in tactical casualty care simulations. METHOD: three rubrics for the application of a tourniquet, an emergency bandage and haemostatic agents recommended by the Hartford Consensus were developed and validated. Validity and reliability were studied. Validation was performed by 4 experts in the field and 36 nursing participants who were selected through convenience sampling. Three rubrics with 8 items were evaluated (except for the application of an emergency bandage, for which 7 items were evaluated). Each simulation was evaluated by 3 experts. RESULTS: an excellent score was obtained for the correlation index for the 3 simulations and 2 levels that were evaluated (competent and expert). The mean score for the application of a tourniquet was 0.897, the mean score for the application of an emergency bandage was 0.982, and the mean score for the application of topical haemostats was 0.805. CONCLUSION: this instrument for the evaluation of nurses in tactical casualty care simulations is considered useful, valid and reliable for training in a prehospital setting for both professionals who lack experience in tactical casualty care and those who are considered to be experts.


Assuntos
Serviços Médicos de Emergência/normas , Tratamento de Emergência/normas , Adulto , Feminino , Hemorragia , Humanos , Masculino , Incidentes com Feridos em Massa , Reprodutibilidade dos Testes , Torniquetes
10.
Plast Reconstr Surg ; 145(5): 1197-1203, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32332539

RESUMO

BACKGROUND: The authors conducted a prospective study to compare patients' intraoperative experience of open carpal tunnel release under "wide awake, local anesthesia, no tourniquet" (WALANT) on the one hand and intravenous regional anesthesia on the other. The authors hypothesized that WALANT would offer a better intraoperative experience than intravenous regional anesthesia. METHODS: Twenty-four patients with bilateral carpal tunnel syndrome had one hand operated on using WALANT and the contralateral hand with the intravenous regional anesthesia method. At the postoperative second hour, patients completed a questionnaire to quantify their pain levels on a numerical rating scale and compare the operation with dental procedures. They were also asked about their expectations and feelings about reoperation with the anesthesia methods. The results were compared for the two anesthesia methods. RESULTS: There were no significant differences between numerical rating scale pain values during anesthetic administration or for surgical site pain on the WALANT and intravenous regional anesthesia sides. Patients reported moderate tourniquet pain for intravenous regional anesthesia sides. For WALANT sides, a significantly higher number of patients reported carpal tunnel release to be an easier procedure than dental procedures (91.6 percent WALANT and 37.5 percent intravenous regional anesthesia). For WALANT sides, a significantly higher number of patients reported carpal tunnel release to be an easier procedure than they expected (91.6 percent WALANT and 50 percent intravenous regional anesthesia). For the reoperation, 83.3 percent of patients preferred WALANT, 8.3 percent preferred intravenous regional anesthesia, and 8.3 percent reported no preference. CONCLUSIONS: WALANT offered a better intraoperative experience. Tourniquet pain, preoperative preparation basics, and the extended anesthesia duration are likely the major drawbacks of the intravenous regional anesthesia method.


Assuntos
Anestesia Intravenosa/métodos , Anestesia Local/métodos , Síndrome do Túnel Carpal/cirurgia , Descompressão Cirúrgica/efeitos adversos , Dor Pós-Operatória/diagnóstico , Adulto , Descompressão Cirúrgica/instrumentação , Descompressão Cirúrgica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/etiologia , Preferência do Paciente , Estudos Prospectivos , Torniquetes/efeitos adversos , Vigília
11.
BMC Infect Dis ; 20(1): 247, 2020 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-32216761

RESUMO

BACKGROUND: Tourniquets used for peripheral venous vascular access such as blood sampling are regularly contaminated in clinical routine. Although most contaminations are harmless, some pose a possible risk for infection. To improve peripheral venous access infection control standards, tourniquets with no or as few as possible bacterial burden should be used. Conventional tourniquets can be reprocessed by autoclaving or by incubating in disinfectants. However, both methods are time-consuming and not suitable for immediate use between patients. In contrast, silicone tourniquets can be quickly and simply reprocessed with wipe disinfection. In vitro studies from the manufacturer have demonstrated reduced bacterial contamination on silicone tourniquets after usage compared to conventional tourniquets. This study aims to independently investigate the bacterial load on both types of tourniquets in clinical routine. METHODS: In a first trial, new conventional and silicon tourniquets were used for blood sampling in one facility with strict guidelines for reprocessing (after each patient or not at all) for 1 day and tested for bacterial contamination. In a second trial, new tourniquets were used in four facilities while the mode and frequency of tourniquets' reprocessing was defined individually by each facility. The number of treated patients, mode and frequency of reprocessing and other relevant handling measures were documented. RESULTS: Under controlled conditions, with strictly specified reprocessing, slightly fewer bacteria were found on silicone than on conventional tourniquets. In routine clinical practice the reprocessing frequency was not higher for silicone tourniquets in practice. Yet, in all four facilities, there were significantly fewer bacteria found on silicone than on conventional tourniquets. CONCLUSION: Although tourniquets are classified as non-critical medical devices, results show - together with benefits of faster and easier reprocessing - that silicone tourniquets can improve infection control of venous vascular access.


Assuntos
Infecção Hospitalar/microbiologia , Infecção Hospitalar/prevenção & controle , Testes Diagnósticos de Rotina/instrumentação , Contaminação de Equipamentos/prevenção & controle , Silicones , Torniquetes/microbiologia , Bactérias , Carga Bacteriana , Desinfetantes , Desinfecção/métodos , Humanos
12.
J Spec Oper Med ; 20(1): 47-54, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32203606

RESUMO

BACKGROUND: Pressure is an important variable in emergency use limb tourniquet science. This study characterizes one system for measuring tourniquet-applied pressure. METHODS: A neonatal blood pressure cuff bladder was inflated to target pressures over atmospheric. Unconstrained or constrained within 1-inch tubular polyester webbing, the neonatal cuff was placed in a 500mL Erlenmeyer flask. A 3-hole stopper provided connections to flask interior (chamber) and bladder pressure sensors and a 60mL syringe for altering chamber pressure: atmospheric to >1500mmHg absolute to atmospheric. RESULTS: Within a finite range of chamber pressures, the neonatal cuffbased system accurately indicates applied pressure (minimum and maximum 95% confidence interval linear regression slopes of 0.9871 to 0.9953 and y-intercepts of -0.1144 to 2.157). The visually defined linear response ranges for bladder inflation pressures were as follows for unconstrained/ constrained: 100 to 400mmHg unconstrained/450mmHg constrained for 10mmHg, 150 unconstrained/100 constrained to 450mmHg for 12mmHg, 150 to 500mmHg for 15mmHg, 150 to 500mmHg unconstrained/550mmHg constrained for 18mmHg, 150 to 550mmHg for 21mmHg. Below the linear response range, the inflated bladder system indicated higher pressures than chamber pressures. Above the linear response range, the system indicated progressively lower pressures than chamber pressures. CONCLUSIONS: Within the linear response range, the bladder pressure accurately indicates surface-applied pressure.


Assuntos
Determinação da Pressão Arterial/instrumentação , Extremidades , Pressão , Torniquetes , Humanos , Reprodutibilidade dos Testes
13.
Plast Reconstr Surg ; 145(3): 737-744, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32097317

RESUMO

BACKGROUND: Open carpal tunnel release is commonly performed with the use of a tourniquet. The combination of local anesthetic and epinephrine with a pneumatic tourniquet helps provide clear visualization during decompression of the median nerve. There has been a rapid expansion of literature challenging the use of tourniquets in open carpal tunnel release. Consequently, the local anesthesia/no tourniquet approach has become increasingly popular. The authors evaluated the outcomes of awake open carpal tunnel release with and without a tourniquet. METHODS: The authors attempted to identify all relevant studies, regardless of language or publication status. A systematic database search for relevant studies was conducted in MEDLINE, EMBASE, EBSCO, and CENTRAL. Included studies compared patients undergoing awake open carpal tunnel release with and without an arm or forearm tourniquet. RESULTS: Eight studies evaluating 765 patients and 866 hands were included. Open carpal tunnel release with the wide awake, local anesthesia, no tourniquet approach resulted in a 2.14 point reduction on the visual analog scale (95% CI, 1.30 to 2.98; p < 0.001). The procedure was 1.82 minutes faster with the use of a tourniquet (95% CI, -3.26 to -0.39; p = 0.01). There were no significant differences between groups in intraoperative blood loss, surgeon perceived difficulty, and complications. CONCLUSION: This systematic review found that tourniquet use causes significantly more pain with no significant clinical benefit as compared with using a wide awake, no tourniquet approach in carpal tunnel decompression.


Assuntos
Síndrome do Túnel Carpal/cirurgia , Descompressão Cirúrgica/métodos , Nervo Mediano/cirurgia , Dor Pós-Operatória/diagnóstico , Torniquetes/efeitos adversos , Perda Sanguínea Cirúrgica/prevenção & controle , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Descompressão Cirúrgica/efeitos adversos , Descompressão Cirúrgica/instrumentação , Descompressão Cirúrgica/normas , Epinefrina , Humanos , Medição da Dor/estatística & dados numéricos , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Guias de Prática Clínica como Assunto , Torniquetes/normas , Resultado do Tratamento , Vasoconstritores/administração & dosagem , Vigília
15.
Rev Col Bras Cir ; 46(6): e20192324, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31967244

RESUMO

OBJECTIVE: to present a low-cost model for bleeding control training with the use of a tourniquet and the results of the training evaluation. METHOD: low-cost and easy-to-purchase materials, such as upholstery foam, ethylene-vinyl acetate (EVA) sheet, plastic propulsion pump, saline container, water, school paint, serum equipment, rubber tubing for tourniquet, and a leg and an arm of a ghost mannequin, were used. In the model assembly, we created an active bleeding simulation system, which could only be controlled with the correct application of the tourniquet. The model was submitted to professional and academic evaluation. RESULTS: the model was similar to human anatomy, proved to be practical in the bleeding control training with the use of a tourniquet, and had low cost. CONCLUSION: the model for bleeding control training had excellent acceptability, was considered viable for educational purposes of tourniquet use, and had low cost.


Assuntos
Desenho de Equipamento/instrumentação , Pessoal de Saúde/educação , Hemorragia/terapia , Treinamento por Simulação/métodos , Torniquetes/economia , Adulto , Desenho de Equipamento/economia , Feminino , Humanos , Masculino , Treinamento por Simulação/economia , Inquéritos e Questionários
16.
Clin Anat ; 33(3): 440-445, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31908028

RESUMO

INTRODUCTION: This study evaluated whether tapping enhances vasodilation in individuals with veins that are relatively difficult to palpate. MATERIALS AND METHODS: Twenty participants (4 men and 16 women, aged 19-22 years) with cutaneous veins that were relatively difficult to palpate even after tourniquet application were recruited. A crossover trial with/without tapping (10 times in 5 s) was performed under tourniquet inflation on the upper arm. Vasodilation was evaluated by venous cross-sectional area, depth of the vein, and elevation of the overlying skin by ultrasonography. Venous palpation scores were also measured. The degree of improvement was estimated by simulation. RESULTS: In total, 60% of participants "sometimes" or "often" experienced unsuccessful venipuncture. After the tapping procedure, the venous cross-sectional area significantly increased (14.6 ± 9.12 mm2 for control and 15.2 ± 9.79 mm2 for tapping) and venous depth significantly decreased (4.57 ± 2.31 mm for control and 4.23 ± 2.41 mm for tapping). A simulation study using these values suggested that tapping increased the longitudinal and crosswise successful ranges of venipuncture by 5-6%. CONCLUSIONS: Tapping in this study enhanced the vasodilation of cutaneous veins that are relatively difficult to palpate. The effectiveness of various vasodilation methods may be compared through the estimation of improvement.


Assuntos
Antebraço/irrigação sanguínea , Palpação/métodos , Flebotomia/métodos , Torniquetes , Vasodilatação , Estudos Cross-Over , Feminino , Antebraço/diagnóstico por imagem , Voluntários Saudáveis , Humanos , Masculino , Ultrassonografia , Adulto Jovem
17.
Plast Reconstr Surg ; 145(2): 459-467, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31985641

RESUMO

BACKGROUND: Injuries to the upper extremity lymphatic system from cancer may require measures to prevent secondary lymphedema. Guidelines were established relating to the use of tourniquet and elective hand and upper extremity surgery. However, reports in the setting of hand surgery have indicated that prior guidelines may not be protective to the patient. METHODS: The study systematically reviewed the current literature evaluating elective hand surgery in breast cancer patients. The authors evaluated the risk of complications, including new or worsening lymphedema and infection. RESULTS: One hundred ninety-eight abstracts were identified, and a bibliographic review was performed. Nine studies pertained to our subject, and four were included for final review. All studies included patients with prior breast cancer treatment involving breast surgery and axillary lymph node dissection. Pneumatic tourniquets were used during nearly all operations. Patients without presurgery ipsilateral lymphedema had a 2.7 percent incidence of developing new lymphedema and a 0.7 percent rate of postoperative infection. Patients with presurgery lymphedema had a 11.1 percent incidence of worsening lymphedema and a 16.7 percent rate of infection. However, all cases of new or exacerbated lymphedema resolved within 3 months. Tourniquet use was not found to increase rates of lymphedema. CONCLUSIONS: Based on the available evidence, there is no increased risk of complications for elective hand surgery in patients with prior breast cancer treatment. Breast cancer patients with preexisting ipsilateral lymphedema carry slightly increased risk of postoperative infection and worsening lymphedema. It is the authors' opinion and recommendation that elective hand surgery with a tourniquet is not a contradiction in patients who have received previous breast cancer treatments.


Assuntos
Neoplasias da Mama/cirurgia , Mãos/cirurgia , Linfedema/cirurgia , Neoplasias da Mama/complicações , Neoplasias da Mama/radioterapia , Síndrome do Túnel Carpal/etiologia , Síndrome do Túnel Carpal/cirurgia , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Humanos , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/métodos , Linfedema/complicações , Mastectomia/efeitos adversos , Mastectomia/métodos , Segurança do Paciente , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Cirurgia de Second-Look/estatística & dados numéricos , Biópsia de Linfonodo Sentinela/efeitos adversos , Biópsia de Linfonodo Sentinela/métodos , Infecção da Ferida Cirúrgica/etiologia , Torniquetes , Resultado do Tratamento
18.
Knee ; 27(1): 249-256, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31911082

RESUMO

OBJECTIVES: To study the significance of checking post-operative hemoglobin and hematocrit following unicompartmental knee arthroplasty (UKA). SETTING: Single center. Multiple surgeons. DESIGN: Retrospective case series. Level of evidence IV. MATERIALS AND METHODS: Following institutional approval, a retrospective analysis of all patients undergoing UKA at our level one academic university hospital was conducted. Operative records of all patients undergoing primary UKA were reviewed between March 2016 and March 2019. Patients' pre-operative hemoglobin and hematocrit, BMI, co-morbidities, application of tourniquet, tourniquet time, administration of tranexamic acid, need for post-operative blood transfusion, hospital length of stay, complications, and re-admission were all recorded. Blood loss was estimated using the post-operative hematocrit. RESULTS: A total number of 155 patients were included. There were 70 females (45%) and 85 males (55%). The mean age was 66 ±â€¯10 years. Median pre-op blood volume was 4700 mLs (interquartile range (IQR); 4200-5100). Median blood loss was 600 mLs (IQR; 400-830). Mean pre-op hemoglobin was 135 ±â€¯14 g/L and mean post-op hemoglobin was 122 ±â€¯13 g/L. No patient had a post-op hemoglobin under 80 g/L (range 93-154). No patients in our study needed transfusion. CONCLUSION: The results of our study indicated that post-operative hemoglobin and hematocrit check proved unnecessary in all of our patients and could have been omitted from post-operative routines. We conclude that routine post UKA check of hemoglobin and hematocrit can be avoided and be saved for special circumstances depending on patient's physiology.


Assuntos
Anemia/diagnóstico , Artroplastia do Joelho/efeitos adversos , Transfusão de Sangue , Hemoglobinas/análise , Idoso , Anemia/sangue , Anemia/etiologia , Anemia/terapia , Artroplastia do Joelho/métodos , Perda Sanguínea Cirúrgica , Testes Diagnósticos de Rotina , Feminino , Hematócrito , Humanos , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/terapia , Período Pós-Operatório , Estudos Retrospectivos , Torniquetes
19.
J Trauma Acute Care Surg ; 88(5): 644-647, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31977996

RESUMO

BACKGROUND: Tourniquet use for extremity hemorrhage has become a mainstay in adult trauma care in last 15 years. The efforts of the Stop the Bleed campaign have increased the distribution and use of tourniquets in civilian settings in response to mass shootings and as part of disaster preparedness. Little research or published experience exists regarding the use of tourniquets in the pediatric population. This study sought to determine the minimum patient age on which the combat application tourniquet (CAT) is able to control extremity hemorrhage. METHODS: A convenience sample of pediatric patients, ages 1 year to 8 years, scheduled for elective orthopedic surgery at an academic hospital, were eligible for enrollment. Subject age, weight, height, blood pressure, and arm and leg circumferences were obtained. Once under general anesthesia, the pulse of an upper and a lower limb were obtained by Doppler, a CAT was then placed at the most proximal practical location of the limb until the corresponding pulse was either no longer obtainable by Doppler or until the tourniquet was as tight as its design allows. The tourniquet was removed after 30 seconds of arterial occlusion. RESULTS: Thirteen children, ages 2 years to 7 years were enrolled. Weights ranged from 12.8 kg to 23.9 kg, with a mean of 16.7 kg. Leg circumferences were 24.5 cm to 34.5 cm, with a mean of 27.9 cm and arm circumferences were 13 cm to 24 cm, with a mean of 16.3 cm. Subject heights were 87 cm to 122 cm, with a mean of 103.4 cm. Twenty-four total extremities were tested, 11 arms and 13 legs. Arterial occlusion was obtained on 100% of limbs tested (95% confidence interval, 85.8-100%). CONCLUSION: This study is similar to previous adult tourniquet efficacy studies in design, size and outcomes. It is the first to show successful arterial occlusion on preschool-aged children with a commercial tourniquet in a controlled setting. The results suggest that the CAT can be used in school-aged children with severe extremity hemorrhage with a high likelihood of success. LEVEL OF EVIDENCE: Therapeutic, level II.


Assuntos
Traumatismos do Braço/terapia , Hemorragia/terapia , Técnicas Hemostáticas/instrumentação , Traumatismos da Perna/terapia , Oclusão Terapêutica/instrumentação , Torniquetes , Fatores Etários , Traumatismos do Braço/complicações , Artérias/diagnóstico por imagem , Criança , Pré-Escolar , Desenho de Equipamento , Feminino , Hemorragia/etiologia , Humanos , Traumatismos da Perna/complicações , Masculino , Oclusão Terapêutica/métodos , Resultado do Tratamento , Ultrassonografia Doppler
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA