Podcasts about Debridement

Advances in Skin & Wound Care - Words on Wounds Podcast

Play Episode Listen Later Sep 23, 2022 36:00

In normal times, once you have stopped the bleeding and applied a splint or dressing, the emergency is “over.” You sit and wait for an ambulance or rescue helicopter to arrive and your part is over. In an austere setting, however, the medic must follow the status of the wound for more than a few minutes or hours. You're in charge until the person is fully recovered. Constant, diligent wound care is your responsibility. It's important to understand that a wound is not just a “hole”; it's part of a person who should be informed of your plan of action and participate, if possible, in their care. Most wounds will heal completely over time, but some may never achieve full recovery. Due to massive injuries or complicating conditions such as diabetes, the best care may sometimes yield a less-than-optimal result even in good times. The medic's duty is to care for the patient the best they can with the limited supplies and technology available off the grid. In this episode, Dr. Joe Alton discusses daily wound care in austere settings, including the removal of non-viable tissue using sharp debridement. It ain't pretty, but if you're the medic, it's you that has to do it. Also, questions that preppers should ask their doctors when told to take a new drug or get a serious diagnostic test. All this and more on the Survival Medicine Podcast! Wishing you the best of health in good times or bad, Joe Alton MD Hey fill those holes in your medical knowledge and supplies with award-winning books, kits, and supplies at store.doomandbloom.net!

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Episode 12 - The Return of the Wound Queen

The Skin Flint Podcast

Play Episode Listen Later Jun 10, 2022 31:47

In this episode John, Sue and Paul welcome Georgie Hollis back to the platform for the second half of their discussion of all things wound-related. Log this CPD with 1CPD here SHOW NOTES Intro (00:14) John re-introduces the ‘Queen of Wounds' conversation from last episode's part one. Chapter 1 – Debridement or indeed 'debridement' in French (01:00) Sue asks about biofilms and how she would suggest dealing with this slime over the wound. Georgie touches on diabetic foot ulcers and uses a pepper analogy for bacteria, saying a sprinkling of bacteria like pepper on the chips is where you can shake the chips and the pepper comes off. Colonisation is where the pepper is sticking to the chips and isn't going to move, and biofilm is where the pepper has now forming its own protein coat around it and the vinegar is not going to penetrate it. So, biofilm formation is an important consideration as the body can't remove them – it is hard to see them and know when you have them and so it is hard to know if you have removed them. You can use some antiseptic solutions to help remove these such as hypochlorous or PHMVs. (03:35) Sue asks about honey and whether this is helpful. Georgie says honey is useful for wounds with yellow debris, as this has some properties to remove dead tissue and so is a debriding agent as well as an antiseptic. So using the yellow stuff on the yellow wounds, which gets rid of the bioburden and then the antiseptic gets rid of the contamination. (05:27) John asks about debridement and when you would do this. Georgie says debridement gets rid of non viable tissue, where it had been damaged and the blood supply has been cut off – this is protein rich material and the bacteria will eat this and therefore you don't want it in the wound. Manual removal of as much as possible using a scalpel under anaesthetic or with products such as honey, called autolytic debridement which uses osmosis by using sugar to draw out the dead stuff much like a poultice (07:24) Sue asks about medical maggots and Georgie says these rather than autolytic debridement magots use enzymatic debridement where you use enzymes to break down dead tissue. So the maggots vomit the enzyme protease into the wound and this makes a protein soup which they then eat and then they poo into the wound which has been shown to have beneficial effects on granulation tissue. (08:41) John asks then whether this pushes the owners again to go to the vet to make the decision as to whether debridement is necessary. Georgie agrees and says this goes further, where there may be different times when this is necessary, talking about a process of demarcation; so it may not be that you can tell which part of the wound is going to die and need debridement straight away. This is an important consideration, because you don't want to cut off skin which may still be viable, meaning that it still has a blood supply and could play an important role in reducing the size of the wound. Chapter 2 - Dressings (10:03) Sue asks about what considerations there are with selection of wound dressings and Georgie says you need three boxes in the cupboard. 1) dressings that help you debride, and clean the wound up and help it granulate. 2) dressings that donate moisture, to stop the wound drying out – citing a study from 1962 be George Winter which showed from pigs with wounds left open to the air that they healed 30-50% slower that wounds kept moist and covered. All of our modern selection of dressings is based upon this principle of keeping the wound moist as a result of this understanding, and it is important that these dressings are left in place long enough for the wound to heal, as changing the dressing too regularly can remove cells regenerated on the wound. 3) dressings that absorb moisture absorb exudate and hold moisture to the wound as long as possible to aid healing, such as super absorbent foam dressings for large wounds. So, this is a balancing act and an art, selecting the dressing according to the type of wound and what any given wound is doing at any given time. For example, in the inflammatory, early stage there is a lot of exudate as the white blood cells work on the wound and then as the wound begins to granulate it starts to dry and a different dressing would be needed. There are many factors which will affect when and how a wound will be at each stage and Georgie lists some of these in context of areas and breeds and species. (15:07) John asks if there are any tips on bandaging difficult areas and Georgie says there are and cites an example, a good product is a fingertip gauze you can tape on to protect the tail and John mentioned dog ends as a product on the veterinary market for this. Georgie stresses the important of anchoring this to the tail and describes this. Chapter 3 – Georgie's 10 Top Tips (17:44) John asks for Georgie's top ten hints for caring for wounds. Nominate a wound nurse, to look after dressings and help people in the practice. Be sure to lavage a wound and as soon as possible. Don't use toxic antimicrobials in wounds as discussed. Organise the dressing cupboard in ways as discussed. Chuck out sudocreme! Georgie feels there are better products out there. Review bandaging techniques as this might not be the best. Don't use honey out of a jar, medical grade honey should be used, as there could be contamination in a jar of honey for food. First aid kit, having a salt solution in a water bottle and hypochlorous and get your pet to the vet as soon as possible. Puncture wounds can be serious. Sue says if it isn't working ask for help, whether an owner, nurse or vet. As muddling on isn't on the animal's best interest, and Georgie wholeheartedly agrees. (24:51) Sue asks about sustainability and how sustainable wound care is and Georgie has been thinking about this recently. Wound dressing manufacture for example is a factor, citing that manuka honey being derived from New Zealand, shipped to the UK for manufacture and then shipped back to New Zealand. She also talks about the repeat use of a Robert Jones bandaging as a huge use of recourses and sustainability gives a good reason to use a cast for this bandage type. Outro (29:39) John wraps up the conversation with a final-off-the-wall question and Georgie plugs a friend's company which sustainably repairs surgical equipment Fix Your Kit

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For Nurses by Nurses: Debridement Best Practices

Play Episode Listen Later Mar 8, 2022 5:24

In this episode of Words on Wounds, Dr. Kevin Woo interviews Erin Rajhathy, RN, BScN, MClSc-WH, NSWOC, WOCC(C) about her work clarifying debridement best practice recommendations for wound, ostomy, and continence nurses in Canada.

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Newsworthy Grab Bag, Trusty Tip on CBR for Podiatry Nail Debridement with E/M, and Agatha Christie's Spark

Paint The Medical Picture Podcast

Play Episode Listen Later Mar 2, 2022 25:34

Welcome to the Paint The Medical Picture Podcast, created and hosted by Sonal Patel, CPMA, CPC, CMC, ICD-10-CM. Help Sonal kick off her 2nd year of podcasting by supporting it!! Sonal's 5th Season begins and Episode 9 features her new Newsworthy Grab Bag session. Trusty Tip features Sonal's compliance recommendations for the second CBR of 2022 - the new CBR report issued on Podiatry Nail Debridement with E/M Services. Spark inspires us all to reflect on clarity and focus based on the inspirational words of Agatha Christie. Paint The Medical Picture Podcast now on: Anchor: https://anchor.fm/sonal-patel5 Spotify: https://open.spotify.com/show/6hcJAHHrqNLo9UmKtqRP3X Apple Podcasts: https://podcasts.apple.com/us/podcast/paint-the-medical-picture-podcast/id1530442177 Google Podcasts: https://podcasts.google.com/feed/aHR0cHM6Ly9hbmNob3IuZm0vcy8zMGYyMmZiYy9wb2RjYXN0L3Jzcw== Amazon Music: https://music.amazon.com/podcasts/bc6146d7-3d30-4b73-ae7f-d77d6046fe6a/paint-the-medical-picture-podcast Breaker: https://www.breaker.audio/paint-the-medical-picture-podcast Pocket Casts: https://pca.st/tcwfkshx Radio Public: https://radiopublic.com/paint-the-medical-picture-podcast-WRZvAw Find Paint The Medical Podcast on YouTube: https://www.youtube.com/channel/UCzNUxmYdIU_U8I5hP91Kk7A Find Sonal on LinkedIn: https://www.linkedin.com/in/sonapate/ And checkout the website: https://paintthemedicalpicturepodcast.com/ If you'd like to be a sponsor of the Paint The Medical Picture Podcast series, please contact Sonal directly for pricing: PaintTheMedicalPicturePodcast@gmail.com --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/sonal-patel5/message Support this podcast: https://anchor.fm/sonal-patel5/support

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Current Evidence in Open Fracture Management, with special guest Gerard Slobogean

OrthoJOE

Play Episode Listen Later Dec 20, 2021 30:28

In this episode, Marc and Mo are joined by special guest Gerard Slobogean, MD (Associate Professor and Director of Clinical Research, Department of Orthopaedics, University of Maryland School of Medicine) in an insightful conversation on the current issues and challenges related to the treatment of, and research into, open fractures. OrthoJOE Mailbag: feedback, comments, and suggestions from our audience can be sent to orthojoe@jbjs.org Links: Chang Y, Bhandari M, Zhu KL, Mirza RD, Ren M, Kennedy SA, Negm A, Bhatnagar N, Naji FN, Milovanovic L, Fei Y, Agarwal A, Kamran R, Cho SM, Schandelmaier S, Wang L, Jin L, Hu S, Zhao Y, Lopes LC, Wang M, Petrisor B, Ristevski B, Siemieniuk RAC, Guyatt GH. Antibiotic Prophylaxis in the Management of Open Fractures: A Systematic Survey of Current Practice and Recommendations. JBJS Rev. 2019 Feb;7(2):e1. doi: 10.2106/JBJS.RVW.17.00197. PMID: 30724762. https://jbjs.org/reader.php?id=205004&rsuite_id=1938010&native=1&source=JBJS_Reviews/7/2/e1/abstract&topics=ta#info Foote CJ, Tornetta P 3rd, Reito A, Al-Hourani K, Schenker M, Bosse M, Coles CP, Bozzo A, Furey A, Leighton R; GOLIATH Investigators. A Reevaluation of the Risk of Infection Based on Time to Debridement in Open Fractures: Results of the GOLIATH Meta-Analysis of Observational Studies and Limited Trial Data. J Bone Joint Surg Am. 2021 Feb 3;103(3):265-273. doi: 10.2106/JBJS.20.01103. Erratum in: J Bone Joint Surg Am. 2021 Mar 17;103(6):e25. PMID: 33298796. https://www.jbjs.org/reader.php?id=207441&rsuite_id=2681010&native=1&topics=ta&source=The_Journal_of_Bone_and_Joint_Surgery%2F103%2F3%2F265%2Ffulltext#content/contributor_reference_11 PREP-IT Trial: https://www.prepittrial.com/ Stennett CA, O'Hara NN, Sprague S, Petrisor B, Jeray KJ, Leekha S, Yimgang DP, Joshi M, O'Toole RV, Bhandari M, Slobogean GP; FLOW Investigators. Effect of Extended Prophylactic Antibiotic Duration in the Treatment of Open Fracture Wounds Differs by Level of Contamination. J Orthop Trauma. 2020 Mar;34(3):113-120. doi: 10.1097/BOT.0000000000001715. PMID: 32084088; PMCID: PMC8077225. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8077225/

OTA 2021 Annual Meeting Notable Paper P109 - How Long Can Debridement Wait in Type IIIB Open Tibia Fractures?

The OTA Podcast

Play Episode Listen Later Nov 30, 2021 13:55

Join host Dr. Paul Whiting and Dr. CJ Foote as they discuss the Notable Paper on timing of debridement in open tibia fractures. This paper was presented at the OTA 2021 Annual Meeting. For additional educational resources visit https://ota.org/

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Modern Ultrasonic Debridement and Aerosol Management with Chrissy Ford, RDH

The Best Practices Show

Play Episode Listen Later Oct 22, 2021 52:27

Modern Ultrasonic Debridement and Aerosol Management Episode #347 with Chrissy Ford, RDH Aerosol management is vital during COVID-19. And the limits on ultrasonics and other aerosol-producing procedures creates a perfect opportunity for clinicians to relearn forgotten protocols for hand instruments and ultrasonics. Today's expert, Chrissy Ford, founder and CEO of Advanced Hygiene Solutions, shares tips, techniques, and things to consider when returning to manual procedures. She also shares advice for effectively and efficiently using ultrasonics to maximize comfort and hygiene for patients. For the best practices on getting the most out of ultrasonics for COVID-19 and beyond, listen to Episode 347 of The Best Practices Show! Main Takeaways: Aerosol capture should be the number-one consideration during COVID-19. Now, more than ever, the quality of hand instruments is very important. Returning to hand instruments, ergonomics for hygienists should be considered. There is a lack of ultrasonic insert selection in most clinics. Many hygienists are not using the correct ultrasonic inserts for each case. They are also using a higher power setting than necessary, which creates more aerosols. Hygienists are forgetting to check their inserts for wear, which reduces clinical performance. ReLeaf, DryShield, and Isodry is not recommended for primary aerosol capture. When used correctly, HVE can be 90% to 98% effective in aerosol reduction. Quotes: “What is hygiene going to look like during COVID-19 and beyond? Obviously, none of us have that crystal ball. Some of us are back to work, so some people have that sense a little bit more than others, what it's going to look like. Obviously, it's going to look different for different people, depending on where you are, depending on what your state and your provincial guidelines are going to allow you to be doing. I think it's safe to say that the majority of us are going to be limiting our aerosol-producing procedures for a while. So, our polishing, our airflow debridement, our ultrasonic scaling, is going to be set aside for a little bit.” (00:57—01:31) “Many hygienists are cringing at the thought of hand scaling only. And don't get me wrong, I'm right there with you. But we have to persevere through that and push through and know that we're going to be doing this for our patients. And they need us.” (01:33—01:47) “Life without ultrasonics, que the tear down my face. I know a lot of hygienists are feeling the same. We rely on our ultrasonics a lot. And what is that going to mean for our hygiene appointments? It is going to mean an increased time to get that same job done. So, obviously, we know we're not going back to business as normal, seeing eight patients a day. But we're going to need longer to get the same job done, and hand scaling takes longer than our ultrasonic use on heavier cases.” (02:00—02:28) “We want to be thinking about ergonomics for the hygienist and that clinical strain. Our bodies have been off work for a while, and that muscle memory has been gone. And now, we're hand scaling. And it's hard, ergonomically.” (02:29—02:41) “When we get to that point that we can pick up our ultrasonic scalers again, we want to make sure that we're going to be using them effectively and efficiently, not only to minimize the exposure of our risk with aerosols during COVID-19 but, obviously, we want to make sure that we're going to be having good clinical outcomes while we're doing that, and also for patient comfort as well.” (04:21—04:40) “How are we going to get the most out of our ultrasonics? Lots of different factors with this, but it is essential for the clinicians to operate the ultrasonic scaling device at a minimum effective power for the task at hand. Proper tip selection is a critical step in the implementation of effective and efficient debridement without having unnecessary root damage.” (04:42—05:08) “One thing that I want to talk about is what I notice when I...

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Newsworthy Interview with Terry Fletcher, Trusty Tip on CBR for Wound Debridement, and Harriet Beecher Stowe's Spark

Paint The Medical Picture Podcast

Play Episode Listen Later Aug 4, 2021 60:15

Welcome to the Paint The Medical Picture Podcast, created and hosted by Sonal Patel, CPMA, CPC, CMC, ICD-10-CM. Can you believe it's already August 2021?! Season 3 is in full swing, and Sonal's 14th episode of the season features Terry Fletcher Consulting, Inc. owner, and Newsworthy special guest, Terry Fletcher. Trusty Tip features Sonal's compliance recommendations for the new CBR report issued on Wound Debridement services. Spark inspires us all to reflect on our journeys based on the inspirational words of Harriet Beecher Stowe. Go ahead and listen, subscribe, rate and review! Find Terry Fletcher on various social media platforms at: https://www.linkedin.com/in/terry-a-fletcher-bs-cpc-cemc-ccc-ccs-ccsp-cmc-acs-ca-scp-ca-qmpm-63a3718/ https://www.terryfletcher.net/ https://podcasts.apple.com/us/podcast/codecast-medical-billing-and-coding-insights/id1305926627 Paint The Medical Picture Podcast now on: Anchor: http://anchor.fm/sonal-patel5 Spotify: https://open.spotify.com/show/6hcJAHHrqNLo9UmKtqRP3X Apple Podcasts: https://podcasts.apple.com/us/podcast/paint-the-medical-picture-podcast/id1530442177 Breaker: https://www.breaker.audio/paint-the-medical-picture-podcast Pocket Casts: https://pca.st/tcwfkshx Radio Public: https://radiopublic.com/paint-the-medical-picture-podcast-WRZvAw Find Sonal on YouTube: https://www.youtube.com/channel/UCzNUxmYdIU_U8I5hP91Kk7A Find Sonal on LinkedIn at: www.linkedin.com/in/sonapate Find Sonal on her website: http://paintthemedicalpicturepodcast.com If you'd like to be a sponsor of the Paint The Medical Picture Podcast series, please contact Sonal directly for pricing: PaintTheMedicalPicturePodcast@gmail.com --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/sonal-patel5/message Support this podcast: https://anchor.fm/sonal-patel5/support

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Episode 17: Meet Gaelyn

Beauty After Betrayal™

Play Episode Listen Later Aug 2, 2021 37:11

This episode is a juicy one! Gaelyn Rae Emerson is a relational trauma recovery coach with advanced training in couples relationships, divorce recovery, problematic sexual behavior and sex addiction induced trauma. Gaelynn and I both trained under the Association of Partners of Sex Addicts Trauma Specialists (APSATS) and she came on the podcast to talk about her own previous betrayals and all the incredible nuggets of wisdom she's learned along the way.Her journey with sexual betrayal began when she returned from a three-week business trip and her first husband of five years told her that he'd fallen in love with a woman on the internet and wanted a divorce. After her second marriage ended due to her husband's sex addiction and subsequent betrayals, she reflected a lot on her healing journey in between her two marriages.Now Gaelyn works with hundreds of women who are on their own healing journeys. She divides her time between Minnesota where she coaches clients online through her private practice Women Ever After, and Florida where she's on staff at the CORE Relationship Recovery Center. "The woman I am today would have made different choices but I did not become the woman I am today without making the choices I had made.”And what woman can't relate to that?? Join us and listen in.xoxo, JenniP.S. Gaelyn has three incredible opportunities coming up to work with her this month! On August 12th, she will be starting three new cohorts for her signature divorce support group, Avenue D: Road to Debridement , which is Gaelyn's 12-week online coaching program for women whose relationships DON'T survive the traumatic impact of sexual betrayal. Connect with Gaelyn:Website: www.womaneverafter.comContact: gaelynrae@womeneverafter.comFacebook: https://www.facebook.com/WomenEverAfter Connect with Jenni:Website: www.jennirochelle.comJenni's Facebook community is for women who are reclaiming their lives after betrayal trauma.Jenni hosts a weekly Beauty After Betrayal™ live show on Instagram.

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15. Can you see my scars? Interview with Samuel Moore-Sobel

Happiness Solved

Play Episode Listen Later May 28, 2021 35:18

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Burn Interventions

NPTE Clinical Files

Play Episode Listen Later Apr 14, 2021 17:54

Are you looking for a bundle of Coach K’s Top MSK Cheatsheets? Look no further: www.nptecheatsheets.com Jessica is treating a patient with a partial thickness burn extending down to the papillary layer of the dermis. Which of the following is the physical therapist's PRIMARY ROLE: A. Prepping the wound for primary intention strategies B. Debridement of small and sturdy blisters C. Ensuring mobility of surrounding joints in preparation for surgical intervention D. Desiccation of the burn site Did you get this question wrong?! If you were stuck between two answers and selected the wrong one, then you need to visit www.NPTEPASS.com, to learn about the #1 solution to STOP getting stuck. --- Support this podcast: https://anchor.fm/thepthustle/support

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Debridement: A Fundamental Principle of Wound Treatment

Speaking of Wounds

Play Episode Listen Later Mar 29, 2021 8:05

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Analysis of the Immune Response to Sciatic Nerve Injury Identifies Efferocytosis as a Key Mechanism of Nerve Debridement

PaperPlayer biorxiv neuroscience

Play Episode Listen Later Oct 24, 2020

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2020.10.23.352872v1?rss=1 Authors: Kalinski, A. L., Yoon, C., Huffman, L. D., Duncker, P. C., Kohen, R., Passino, R., Hafner, H., Johnson, C., Kawaguchi, R., Carbajal, K. S., Jara, J. S., Hollis, E., Segal, B., Giger, R. J. Abstract: Sciatic nerve crush injury triggers sterile inflammation within the distal nerve and axotomized dorsal root ganglia (DRGs). Granulocytes and pro-inflammatory Ly6C high monocytes infiltrate the nerve first, and rapidly give way to Ly6C negative inflammation-resolving macrophages. In axotomized DRGs, few hematogenous leukocytes are detected and resident macrophages acquire a ramified morphology. Single-cell RNA-sequencing of injured sciatic nerve identifies five macrophage subpopulations, repair Schwann cells, and mesenchymal precursor cells. Macrophages at the nerve crush site are molecularly distinct from macrophages associated with Wallerian degeneration. In the injured nerve, macrophages "eat" apoptotic leukocytes, a process called efferocytosis, and thereby promote an anti-inflammatory milieu. Myeloid cells in the injured nerve, but not axotomized DRGs, strongly express receptors for the cytokine GM-CSF. In GM-CSF deficient (Csf2-/-) mice, inflammation resolution is delayed and conditioning-lesion induced regeneration of DRG neuron central axons is abolished. Thus, carefully orchestrated inflammation resolution in the nerve is required for conditioning-lesion induced neurorepair. Copy rights belong to original authors. Visit the link for more info

Dermatology Debridement Coding Spotlight

CodeCast | Medical Billing and Coding Insights

Play Episode Listen Later Oct 6, 2020 19:41

This week Terry continues her specialty spotlight coding with debridement coding and understanding how to choose those codes based on specific documentation language. Terry also covers a “hot off the presses” announcement from HHS on the status of the PHE that is set to end 10/26. Subscribe and Listen You can subscribe to our podcasts […] The post Dermatology Debridement Coding Spotlight appeared first on Terry Fletcher Consulting, Inc..

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Debridement

NPTE Clinical Files

Play Episode Listen Later Apr 15, 2020 16:01

Are you looking for an awesome cheatsheet that reviews the facts to know about debridement for the NPTE? Look no further: https://www.kylericeprep.com/lavage Doris undergoing her daily wound care. The treating therapist describes the wound as a 3x5x4cm with pink granulation tissue throughout the wound bed and non-adherent black tissue surrounding the borders. Which of the following interventions is the MOST effective to treat this wound type? A. Whirlpool B. Wet to dry dressings C. Pulsatile lavage at 12 PSI D. Sharps debridement Check out the Podcast for the answer!! Did you get this question wrong?! If you were stuck between two answers and selected the wrong one, then you need to visit www.NPTEPASS.com, to learn about the #1 solution to STOP getting stuck.

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Episode 6 - Wound Care

Rio Bravo qWeek

Play Episode Listen Later Apr 14, 2020 29:58

Learning About Wound Care The sun rises over the San Joaquin Valley, California, today is April 9, 2020.This week, for pregnant patients who are not at increased risk for preterm delivery the USPSTF recommended AGAINST screening for bacterial vaginosis (BV). This is a D recommendation. So, do NOT screen for BV in these patients. For your patients who actually ARE at INCREASED RISK for PRETERM delivery, the data is INSUFFICIENT to recommend screening for bacterial vaginosis. This is an I recommendation. So, you may or may not screen.To recap: Not at risk for preterm delivery = No screening for BV. At risk for preterm delivery = Insufficient data. This week, smiling to our patients has become a little harder to do through a surgical mask. We don’t know how long we will be required to wear a surgical mask to see all patients in clinic. This is the week of “Spring Break”. Movie theaters, museums, parks and many public places are now closed. However, the flowers and trees seem to be unaware of the pandemic and are not in quarantine. They rebelled against the rules and are blooming beautifully this time of the year. The Spring season surely brings optimism for a brighter future. May the Easter weekend be a time of reflection and renewal for you. Our message is: Keep blooming wherever you are planted!Welcome to Rio Bravo qWeek, the podcast of the Rio Bravo Family Medicine Residency Program, recorded weekly from Bakersfield, California, the land where growing is happening everywhere.The Rio Bravo Family Medicine Residency Program trains residents and students to prevent illnesses and bring health and hope to our community. Our mission: To Seek, Teach and Serve. Sponsored by Clinica Sierra Vista, Providing compassionate and affordable care to patients throughout Kern and Fresno counties since 1971.______________________________“Do not correct a fool, or he will hate you; correct a wise man and he will appreciate you.” Adapted from the Holy Bible.Correction, or how we like calling it in education: Feedback, is a good tool to get trained as residents. As a resident, you can decide how you will take that feedback, will you take it as an offense? Will you make a plan to correct the mistake instead? I’ll let you think about it.Dr Manuel Tu is a talented man who is a great asset for our residency program. He has brought an interesting topic to the table today and I am excited to receive him today. Dr Tu is known by his friends and colleagues as Manny. As you know we ask 5 questions, and let’s start with question number 1. Question Number 1: Who are you? Hello everybody my name is Dr Manuel Tu Jr. and presently I am a First-year Family Medicine resident here in Bakersfield, California. I was born and raised in the Philippines, finished my bachelor's degree in Nursing from Perpetual Help College in Manila, and graduated in Medicine from the University of the City of Manila, Philippines. Dr Tu also worked for some years as a nurse for Clinica Sierra Vista and did a fantastic job before his residency. Question number 2: What did you learn this week?This week I would like with you some things about WOUND MANAGEMENT, specifically about the types of wounds, factors that inhibit wound healing and general principles on how to heal a wound. A wound is a disruption of the normal structure and function of the skin and underlying soft tissue. It may be acute like trauma to the skin or chronic like a venous stasis or diabetic ulcer.ACUTE WOUNDSTypically, due to some form of trauma.May be blunt or penetrating causes with different array of sizes, depths, and locations.Abrasion, puncture, crush, burns, gunshot, animal bites, surgery, and other etiologies that cause initially intact skin to break down. CHRONIC WOUNDSAny mechanism that decreases blood flow in the skin for a prolonged period of time has the potential to cause ischemic breakdown of the skin. Skin perfusion may be impaired due to:proximal arterial obstruction (peripheral artery disease)vascular compression (hematoma, immobility causing focal pressure)microvascular occlusion or thrombosis (vasculitis, cholesterol crystals) venous or neuropathic ulcers like in diabetic patients.FACTORS THAT INHIBIT OR AFFECT WOUND HEALING:Infection: Bacterial infection produce multiple inflammatory mediators that inhibit wound healing. The inflammatory phase of healing is prolonged and disrupted, there is depletion of the components of the complement cascade, disruption of the clotting mechanisms, disordered leukocyte function, less efficient angiogenesis and formation of friable granulation tissue. New tissue growth cannot occur in the presence of inflammation or necrotic tissue, and the presence of necrotic tissue promotes bacterial proliferation. A wound that is infected has an unbalanced host-bacteria relationship, because you cannot get rid of all the bacteria on the surface of a wound, but you can establish an equilibrium to promote healing. In 1980 Bucknall published an experiment with rats showing how the granulation tissue looks in an infected wound: There is an increased in hydroxyproline (collagen) and abundant new vessel formation(1). It was interesting for me to know that because I thought those processes ere inhibited but actually, they are increased but are disorganized, resulting in a granulation tissue that is disorganized and friable. Smoking: Nicotine and other chemicals in tobacco impair wound healing by inducing vasoconstriction causing relative ischemia on tissues, also by reducing inflammatory response, impairing bactericidal mechanisms, and altering collagen metabolism. Smoking is associated with postoperative wound healing complications, which occur more often in smokers compared with non-smokers as well as in former smokers compared with those who never smoked(2).Aging: Likely due to comorbidities such as diabetes, peripheral artery disease, chronic venous insufficiency, and lower serum protein levels causing lower collagen. Lower collagen in the body slows down wound healing. For example, Kennedy pressure ulcer.Kennedy Ulcer: It is a dark sore that develops rapidly during the final stages of a person’s life. Not everyone experiences these ulcers in their final days and hours, but they’re not uncommon. They are different from pressure sores or bed sores; because they develop rapidly; they are typically located in the sacral area are necrotic(3). Malnutrition: Patients with hypoalbuminemia tend to be more prone to infection, and infection as we said, affects wound healing. Prealbumin and albumin are not perfect markers of wound healing but helpful specially for patients with non-healing wounds. Diabetes mellitus: Causes several factors that contribute to impaired wound healing: Decreased or impaired growth factor production, angiogenic response; macrophage function, collagen accumulation, quantity of granulation tissue, dysfunctional keratinocyte and fibroblast migration and proliferation. Also, diabetes causes neuropathy and vasculopathy. Trying to explain the pathophysiology of slow und healing in diabetes would take a lecture by itself. Obesity: The cause of wound complications in obese individuals may be secondary to decrease vascularity of the subcutaneous tissue which may impair antibiotic delivery and increased wound tension. Poor skin circulation also makes obese individuals prone to pressure injury which can be aggravated by difficulties in repositioning and increased shearing during movement.Others: Vascular disease (PAD, CVI), immunosuppressive therapy, edema, size and depth of the wound, autoimmune diseases, vasculitis, and many medications. It is impossible to cover all the factors but my message to residents is: When a wound is not healing, think about the most common factors interfering with healing and take them out of the way! Mainly infection, smoking, diabetes and malnutrition.DIFFERENT WAYS TO HEAL WOUNDS: Wound Debridement: It is the removal of non-viable tissue, contaminants, or foreign body to expose healthy wound bed to assist with wound healing. Devitalized tissue refers to slough or eschar. The body normally uses phagocytosis and autolysis to get rid of devitalized tissues, but in some instances those processes are impaired, so we have to assist with debridement. These can be accomplished by different means: surgical (scalpels, scissors, electrocautery), irrigation, chemical (soaps, detergents), enzymatic (collagenases, fibrolysin, DNAsses, i.e. Santyl), and biosurgical (maggots). The point is to eliminate all the dead tissue because it is basically “on the way” and can potentially be an environment where bacteria can thrive. These “excess” tissues are not going to regenerate and need to be removed. Another way to put it is: “Debridement is turning a chronic wound in an acute wound with more potential for healing.” Moist-to-dry dressings: Mechanical debridement can be accomplished by moist-to-dry dressings. We need the proper amount of moisture to promote moist healing environment. Too much moisture or “wet gauze” provides more than needed moisture and it may cause more harm than good, for example, maceration. Get the gauze wet and squeeze it and that should be enough moisture for the wound. Irrigation: Irrigation is a way to remove bacteria and debris. It should be a part of routine wound management. Low-pressure irrigation is done with a syringe or bulb, and high-pressure irrigation is typically performed in the OR with a commercial device. There is no high-level evidence to support the use of any particular additive to the irrigant, nor any particular additive over another. The act of irrigation and the volume of irrigant probably provides the positive benefits. Warm, isotonic (normal) saline is typically used; however, systematic reviews have found no significant differences in rates of infection for tap water compared with saline for wound cleansing. The addition of dilute iodine or other antiseptic solutions (eg, chlorhexidine, hydrogen peroxide, sodium hypochlorite) is generally unnecessary. Such additives have minimal action against bacteria, and some, but not all, may impede wound healing(4).Certification in wound care: As residents, you can start by taking elective rotations on wound care, or attend wound care trainings available for doctors, nurses, physical therapists and other health care professionals. The process results in a Wound Care Certified Certification, but you need an unrestricted license as an MD or RN, or other profession. You need FIRST education and SECOND experience before you can sit for the certification exam. You can find more information on the website of the National Alliance of Wound Care and Ostomy (https://www.nawccb.org/).Question number 3: Why is that knowledge important for you and your patients? Healing wounds is very rewarding. This knowledge is important for me because I want to help my patients with acute and chronic wounds. We encounter patients in the hospital and in the clinic with multiple kinds of wounds, and I feel I can help many people with this knowledge. Question number 4: How did you get that knowledge? I got this knowledge from attending wound care trainings here in Kern County, from reading lecture notes and books, and from years of experience caring for patients with various and complex wounds.Question number 5: Where did that knowledge come from? The information I shared with you came from the books “Skin and Wound Care” by CT Hess, Wound Care Guides, and Uptodate, and you, Dr Arreaza also shared some information with me. __________________________________“Speaking Medical” (Medical word of the Day) by Lisa ManzanaresThe word of the day is proctalgia fugax. What IS that? Well, it’s a pain in the butt. Literally. Proctalgia fugax is a functional anorectal disorder characterized by severe, intermittent episodes of rectal pain that are self-limited. In Latin, fugax means “fleeting.” Patients with proctalgia fugax have attacks of severe anorectal pain that lasts from seconds to minutes, with an average duration of five minutes. The patient with proctalgia fugax is completely asymptomatic between episodes. The diagnosis requires that all other causes of rectal or anal pain are excluded. Proctalgia fugax is estimated to affect 4-18% of the general population, but only about 20% of those affected actually report their symptoms to a physician. Proctalgia fugax usually affects those between 30 and 60 years of age and is more common among women. Some studies have suggested that the pain may be precipitated by stress, sitting, intercourse, defecation, or menstruation, but in many cases is unknown. So there is a term for a temporary pain in the butt, and no, it’s not your ex-boyfriend or girlfriend: it’s proctalgia fugax.__________________________________“Espanish Por Favor” (Spanish Word of the Day) by Claudia CarranzaHi this is Dr Carranza on our section Espanish por favor. This week’s word is “ronquera”. “Ronquera” means hoarseness, or if you want to get more technical it is called dysphonia. In Spanish, people usually use this word when they are complaining of having a hoarse voice. So you may have a patient coming to you saying “Doctor, tengo ronquera,” or “Doctor, estoy ronco,” meaning “Doctor, my voice is hoarse or I have a raspy voice”. At this point you can ask the usual questions of how long? Any precipitating factors? And more. Some people might come in and sound hoarse, in which case you can always ask: Tiene ronquera? To find out if this is abnormal for them or if this is their baseline. Now you know the Spanish word of the day, ronquera or ronco, all you have to do is go and assess your patient’s hoarse voice. Have a great week and take care!__________________________________“For your Sanity” (Medical joke of the day)by Lisa Manzanares, Claudia Carranza, and Terrance McGill-What type of jokes are allowed during the coronavirus? Inside jokes!-What do you call an acid with an attitude? A-MEAN-O-ACID-Why are nails used to seal coffins? To prevent oncologists from cracking them open to give another round of chemo… and What do oncologists see when they finally open the coffin? A note from Nephrology: “Patient taken to dialysis”-I could not decide in med school between proctology and neurology, so I flipped a coin, heads or tails.__________________________________This was our Episode number 6, Learning about Wound Care. During this episode, we learned some basic principles of wound care. It was a good reminder of how infections, smoking, malnutrition and diabetes can affect wound healing, and of the importance of debridement and moist-to-dry dressings to promote healing. Proctalgia fugax made us think of a common condition that may go undiscussed during our clinic visits. The Spanish word ronquera reminded us of hoarseness. And remember that according to psychologists, humor is a MATURE defense mechanism, so we are trying to be “mature” with our jokes. Stay tuned for more interesting topics every week.This is the end of Rio Bravo qWeek. We say good bye from Bakersfield, California, a special place in the beautiful Central Valley of California, United States, a land where growing is happening everywhere.If you have any feedback about this podcast, contact us by email RBresidency@clinicasierravista.org, or by visiting our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. Our podcast team is Hector Arreaza, Lisa Manzanares, Manuel Tu, Claudia Carranza, and Terrance McGill. Audio edition: Suraj Amrutia. See you soon! __________________________________References:1) Cutaneous Wound Healing, Edited by Vincent Falanga, 2001, Martin Dunitz Ltd, a member of the Taylor & Francis group, Florence, Kentucky, USA. 2) Armstrong, David G and Andrew J Meyr, “Risk factors for impaired wound healing and wound complications”, UpToDate, https://www.uptodate.com/contents/risk-factors-for-impaired-wound-healing-and-wound-complications?search=smoking%20consequences&source=search_result&selectedTitle=5~150&usage_type=default&display_rank=5 , accessed on April 9, 2020.3) Kennedy Ulcers: What They Mean and How to Cope, https://www.healthline.com/health/kennedy-ulcer#symptoms , accessed on April 4, 2020.4) Armstrong, David G and Andrew J Meyr, “Basic principles of wound management”, UpToDate, https://www.uptodate.com/contents/basic-principles-of-wound-management?search=wet%20to%20dry%20dressing&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1 , accessed on April 9, 2020.5) Skin and Wound Care by CT Hess 7th Ed, 2012, United States of America

Episódio 18 - Podemos confiar na dissolução tecidual do Hipoclorito de Sódio? Parte 2

ENDOdonto Cast - Endodontia e Odontologia

Play Episode Listen Later Nov 24, 2019 16:43

-----Criador_do_Podcast----- Prof. Nilton Vivacqua Gomes • Especialista, Mestre e Doutor em Endodontia pela UNICAMP. • Professor dos Cursos de Aperfeiçoamento, Especialização e Imersão em Endodontia da ABO-CE (Coordenador) e FAMETRO-CE. • Professor-Coord. do Mestrado de Excelência em Endodontia da Faculdade SL Mandic-CE. • Professor de Endodontia do Mestrado em Clínica Odontológica da FACPP-CE • Professor Convidado dos Cursos de Aperfeiçoamento e Especialização do IOA-Balneário Camboriú-SC. ----------------------------------------- -----Cursos----- Clique nos Links abaixo para: Curso VIP: http://bit.ly/vivacquavip Aperf. e Imersões: http://bit.ly/aperfeic Especializações: http://bit.ly/especializ Materiais - Dentalbox Conceito (85) 98180-9804 ----------------------------------------- -----Apoio----- Você pode apoiar essa iniciativa, para incentivá-la a continuar indefinidamente. É só acessar www.apoia.se/ENDOdontoCast e escolher o valor com o qual deseja apoiar mensalmente. Vale até mesmo 1 real. Quanto maior o valor, maior o benefício. -----Apoiadores----- -Categoria Diamante: Nathalia Rabelo Daniele Miranda Carolina Galindo -Categoria Ouro: Indyanara Chinaqui André Quiudini Igor Trindade Mônica Moura Carlos Henrique Resende Rafael Saulo -Categoria Prata: Sandro Rodrigues Pinheiro Ana Paula Santos Flavia Darius Vivacqua Gabriela Rodrigues ----------------------------------------- -----Podcast_Apps----- Podcasts (Nativo), Overcast, Breaker (IOS), Google Podcasts (Android), Acast, Ivoox, Wecast, Castbox, Spotify, PocketCasts (IOS/Android). Instale o app e na aba busca e procure pelo ENDOdonto Cast. Inscreva-se clicando no botão destinado a isso. Selecione a config. p/ baixar novos episódios automaticamente. ----------------------------------------- -----Referências_Científicas----- The influence of preparation technique and sodium hypochlorite on removal of pulp and predentine from root canals of posterior teeth. Evans et al., Int Endod J, 2001. Sodium hypochlorite with reduced surface tension does not improve in situ pulp tissue dissolution. De-Deus et al., J Endod, 2013. Can the sodium hypochlorite tissue dissolution ability during endodontic treatment really be trusted? An in vitro and ex vivo study. Zaia et al., Dental Press, 2013. The effect of surface tension reduction on the clinical performance of sodium hypochlorite in endodontics. Rossi-Fedele et al. Int Endod J, 2013. Histologic Assessment of Debridement of the Root Canal Isthmus of Mandibular Molars by Irrigant Activation Techniques Ex Vivo. Neelakantan et al., J Endod, 2016. In vivo debridement efficacy of ultrasonic irrigation following hand-rotary instrumentation in human mandibular molars. Gutarts et al., J Endod, 2005. What happens to unprepared root canal walls: a correlative analysis using micro-computed tomography and histology/scanning electron microscopy. Siqueira Jr et al, Int Endod J, 2018. ----------------------------------------- -----Site_e_Contatos----- EndodontiaAvancada.com EndodontiaAvancada.com@gmail.com ----------------------------------------- -----Redes_Sociais----- Instagram/Facebook: NiltonVivacqua LinkedIn: Nilton Vivacqua Twitter: NiltonVivacqua e EndoAvancada* Página/Grupo do Facebook*: EndodontiaAvancada.com -----Perguntas,_Críticas_e_Sugestões----- Envie-nos um e-mail! --- Send in a voice message: https://anchor.fm/endodontiaavancada/message

EM Quick Hits 9 Burn Blister Debridement, ECG Cases, Compartment Syndrome, Pediatric Asthma, Spinal Trauma, Motivational Interviewing P2

Emergency Medicine Cases

Play Episode Listen Later Oct 8, 2019 39:03

Justin Morgenstern on the lack of evidence for burn debridement, Jesse MacLaren on ECG Cases - missed ischemia and pitfalls of "normal" computer ECG interpretations, Arun Sayal on clinical diagnosis pitfalls of compartment syndrome, Sarah Reid on pediatric asthma pitfalls and myths, Andrew Petrosoniak on T-spine and L-spine fracture work-up, Michelle Klaiman & Taryn Lloyd on motivational interviewing part 2... The post EM Quick Hits 9 Burn Blister Debridement, ECG Cases, Compartment Syndrome, Pediatric Asthma, Spinal Trauma, Motivational Interviewing P2 appeared first on Emergency Medicine Cases.

trauma burn syndrome motivational pediatric asthma spinal ecg blister compartment debridement sarah reid justin morgenstern andrew petrosoniak

Survival Medicine Hour: Debridement, Type 2 Diabetes, Ebola 2019

Play Episode Listen Later Sep 28, 2019 53:00

A#366 SURVIVAL MEDICINE HOUR PODCAST You may have heard the phrase "Gone But Not Forgotten" but how about "Forgotten But Not Gone"? For some time, The Democratic Republic of Congo has been in the throes of a deadly epidemic: Ebola. I wrote a lot about the Ebola virus during the 2014 epidemic in West Africa and even wrote a book (published by Skyhorse Publishing) about the disease. In West Africa, more than 28,000 got sick and 11,000 died. This time, more than 2,000 have succumbed to the virus since 2018 but you’d hardly know it with nary a mention in the media.Joe Alton MD tells you about the second deadliest Ebola epidemic in history, even if few others will. Wounds are tough to deal with in any circumstance, but especially if you’re the person taking care of the wound off the grid. Dead tissue doesn’t heal, so you have to make sure you remove every possible bit of it. Debridement is the removal of dead (necrotic) or infected skin tissue to help a wound heal. It’s also done to remove foreign material from tissue. Dr. Bones and Nurse Amy discuss the various types of debridement and when you should consider the procedure. Plus, a listener from Jack Spirko's Survival Podcast asks Dr. Alton about Type II diabetes and more.... All this and more on the Survival Medicine Hour podcast with Joe and Amy Alton! Wishing you the best of health in good times or bad, The Altons Don't forget to fill those holes in your medical storage by checking out Nurse Amy's entire line of kits and supplies at store.doomandbloom.net!

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Survival Medicine Hour: Debridement, Type 2 Diabetes, Ebola 2019

pancreas pancreatic abdomen necrosis acute pancreatitis debridement

Play Episode Listen Later Sep 28, 2019 53:00

dead bones congo wishing wounds west africa ebola democratic republic alton type 2 diabetes type ii gone but not forgotten skyhorse publishing survival podcast jack spirko nurse amy debridement amy alton survival medicine hour

5.1 Abdomen - Pancreas_Acute Pancreatitis, Pancreatic Necrosis, & Pancreatic Debridement

SurgCast

Play Episode Listen Later Sep 15, 2019 13:51

SCORE Modules Covered: Diseases/Conditions: Pancreatitis - Acute/Pancreatic Necrosis/Abscess (Core), Operations/Procedures - Pancreatic Debridement (Core)

Audio Article: The Many Lives of the Mysterious Full Mouth Debridement

Today's RDH Dental Hygiene Podcast

Play Episode Listen Later Jul 22, 2019 7:56

The Many Lives of the Mysterious Full Mouth Debridement By Melissa Turner, BASDH, RDH, EFDA Original article published on Today's RDH: https://www.todaysrdh.com/many-lives-mysterious-full-mouth-debridement/ Podcast audio article sponsored by Philips Sonicare. Follow their Instagram just for dental professionals here: https://www.instagram.com/philipssonicarepro/ Get daily dental hygiene articles at https://www.todaysrdh.com Follow Today's RDH on Facebook: https://www.facebook.com/TodaysRDH/ Follow Kara RDH on Facebook: https://www.facebook.com/DentalHygieneKaraRDH/ Follow Kara RDH on Instagram: https://www.instagram.com/kara_rdh/

mouth mysterious many lives rdh debridement philips sonicare

Chronic Ankle Pain: When Is It Time To See A Doctor?

Medical Intel

Play Episode Listen Later Mar 8, 2019 12:25

Multiple ankle sprains can lead to chronic ankle pain for some patients. Dr. Ali Rahnama explains how minimally invasive surgery can help these patients avoid much larger procedures in the future. TRANSCRIPT Intro: MedStar Washington Hospital Center presents Medical Intel where our healthcare team shares health and wellness insights and gives you the inside story on advances in medicine. Host: We’re speaking with Dr. Ali Rahnama, a foot and ankle surgeon at MedStar Washington Hospital Center. Thank you for joining us, Dr. Rahnama. Dr. Rahnama: Thank you for having me. Host: Today we’re discussing chronic ankle pain after a sprain and what could be going on inside the foot and ankle. Dr. Rahnama, many of us have experienced an ankle sprain. How many would you say you treat in a year? Dr. Rahnama: I would say it really depends on the time of year, especially as we get closer to the winter months. Sometimes I may see as many as 4 to 5 of these a week, sometimes even more. Host: Student athletes and leisure athletes are at risk of sprains. Are there other groups of people who are susceptible? Dr. Rahnama: While it’s true that typically we do see a lot of athletes with sprains because of the increased level of activity that they engage in on a day to day, we do see them in various patient populations and even non-athletes, particularly as we get closer in to the winter months. Slip and falls, especially in cities like Washington where people use a lot of mass transit and are walking outside on the sidewalk. We, a lot of times, see people slip on little patches of ice and things like that, and injure themselves and get sprains and even sometimes fractures. Host: How do you determine whether an ankle sprain is mild, moderate, or severe? Dr. Rahnama: I typically look at three things. I want to see how much tenderness there is, swelling, bruising, that kind of thing, the patient’s ability to bear weight or not be able to bear weight. Those are typically how I determine how bad the injury is. Host: How long should a patient expect to fully recover from a mild or moderate ankle sprain? Dr. Rahnama: Typically, a mild to moderate ankle sprain, I would expect to clear up in the ballpark of about 2 to 4 weeks, depending on how bad the injury is and exactly what part of the ankle they’ve injured. Typically, the lateral ankle ligaments are the ones that are affected more commonly. Those would be the ankle ligaments on the outside, as opposed to the inside ligaments. Host: How long should a patient expect to recover from a severe ankle sprain? Dr. Rahnama: Severe ankle sprains can take anywhere from up to 6 weeks to even up to 12 weeks to heal, depending on the injury. Host: Is there anything special that an individual would have to do when they’re taking care of a severe ankle sprain? Dr. Rahnama: Typically, with a severe ankle sprain, I would say it’s important for them to initially have a period of immobilization, rest, where they can ice it and elevate it and stay off it. And then, it’s really important for them to get with a physical therapy colleague of ours that I’ll very often send my patients to, who will work with them on proprioceptive exercises and strengthening exercises, to help get them to strengthen the tendons and muscles in and around the foot and ankle to help the patient avoid having a similar injury again in the future. Host: Of course, spraining an ankle is painful, but how long does the pain typically last before it’s considered “chronic?” Dr. Rahnama: The chronicity of the sprain isn’t just based on how long it takes for them to heal. It really has to do with how many spraining incidents they’ve had total. So, if I have a patient who comes to me for an acute sprain, meaning that they recently had one and so they’ve decided to present for care, or somebody sent them to me for evaluation, the first thing I want to make sure and ask them is that have they had similar incidences in the past that maybe they didn’t see somebody for and that maybe healed on their own and that now they’re noticing a pattern, where they had an initial sprain, sometimes even up to years ago, and as time has gone on, they, every so often depending on what they’re doing, particularly if they’re active, if they continue to have more and more of these incidences - and, so then, that’s when I start to think that it’s something chronic because there’s multiple episodes of it. Host: So, it’s just being more and more susceptible to sprains? Dr. Rahnama: Exactly right. Host: What’s the standard first-line treatment for a sprain? Dr. Rahnama: So, I would divide it into three things. One, I would say resting and protecting the ankle with a brace or boot, sometimes even a splint. And then second, I would follow that with resting range of motion, strength and stability exercises. And finally, maintenance exercises that would slowly get them back to more intense physical activity and for them to be able to engage in sports that would need sharp cutting, like tennis or basketball, for example. Host: At what point do you typically recommend surgery for an individual with chronic sprains? Dr. Rahnama: Well, first I’d like to emphasize that, even as a foot and ankle surgeon, the vast majority of sprains are treated nonoperatively. Only in the setting where a patient has not healed for more than 6 or 8 to 12 weeks and they’ve oftentimes had multiple incidences of sprains, will I start to think of surgery for correction of it. The surgical procedure is actually quite simple for a straight-forward, isolated, chronic lateral ankle tear, or laxity. We make a small incision, and oftentimes we’ll try minimally invasive techniques where we can make small, few-millimeter stab incisions and enter the joint and evaluate for any type of synovitic or pre-arthritic tissue, debride that. Debridement is when we use a shaver and the guidance of the camera, once we’ve gotten into the joint, to essentially just clean up and take out any of that arthritic or inflammatory tissue that doesn’t belong into the joint. And then we can even do our lateral ankle repair through those same incisions so that we don’t have to make any large incisions and open the patient up. It’s fairly straight-forward surgery. So, they actually did studies where they split two groups of surgeons up who had never done minimally invasive surgery before. And, in the first group, they had the surgeons do video games. And then, they had the other group not do anything at all. And, then they trained all...both groups at the same time in minimally invasive surgery and arthroscopic or laparoscopic surgery. And the group that had had the video game training before the surgical training actually got it a lot faster and did much better. So, if you’ve got a kid at home who’s good with video games, he may be good with minimally invasive techniques someday. Host: When it comes to foot and ankle surgery, why is minimally invasive surgery a good approach? Dr. Rahnama: Minimally invasive surgery is good for patients for a number of reasons. But, probably the most important things are many times patients undergoing minimally invasive surgery get back to doing what they want to do a lot sooner. There are much smaller incisions that need the body to heal them. And so, overall, they tend to have better outcomes, is what we found. Host: Have you ever had a patient come in thinking they had sprained their ankle, but it was actually something else? Dr. Rahnama: So, that’s a great question. We actually see this quite often where somebody will come in with the complaint of a sprain, or what they think to be a sprain, that’s not getting any better and it doesn’t really fit the description of what we would like to see for classifying it as chronic ankle sprainers. And, that’s really when we start to think about, ‘what else could this be, masking itself as an ankle sprain?’ Things like osteochondral defects of the talus, meaning an injury to the cartilaginous surface of one of the bones in the ankle, can cause pain, especially if there’s loose pieces of cartilage from that injury that are now in the joint. Those oftentimes can mask themselves with the same symptoms or similar symptoms as an ankle sprain. Also, tendon injuries can also mask themselves as sprains, where it may really be a tendon tear or even a rupture and the patient comes to us with an ankle sprain that’s just not healing. And so, those would definitely be a couple of things that we see fairly often that patients think are ankle sprains but they’re not. And, obviously, the last thing would be fractures, particularly if the patient was seen in an environment...because a lot of times, primary care offices don’t have X-ray available and so the patient is sent to us with a sprain. And, one of the first things that I’ll do, if the patient doesn’t already have one, is obtain an X-ray to make sure they don’t have any fractures anywhere. Host: What can people do to reduce the risk of ankle sprains? Dr. Rahnama: I would say it’s really important for people to keep in to consideration the type of shoes that they wear and particularly be mindful of the type of activity they’re trying to engage in. Runners, a lot of times here in the city particularly, it’s best for them to try to avoid, especially in the colder months, the wet months, avoid trying to go out for a run right after a snow or the rain. And, in the summer months, when we’re out on trails and things like that, really make sure you know the terrain that you are about to go out for a run in, for example, or embark on any type of physical activity, so that you don’t find yourself with any surprises. So, what I would say is that, particularly in the winter months, if you’re a runner, make sure you have the appropriate shoe gear. Make sure your laces are tied nice and snug. And, maybe avoid the day right after a snow storm. Make sure you know the environment that you’re going to be running in so that you can avoid little slicks of ice and the really wet, deep puddles. Those are really where we see the biggest problems or people will say, “I slipped on a patch of ice,” or “I went off the curb and it was just too wet, and I slipped and I sprained my ankle,” or sometimes even worse. And in the spring and the summer months trail runners - I know that’s very popular these days - familiarize yourself with the terrain that you are about to go on a nice run for. Make sure you understand where there might be a ditch or a hole that you might want to avoid. So, before we go full speed ahead it’s nice to pause and try to really familiarize yourself with our environment. Host: How do you recommend that patients prepare for foot or ankle surgery? Dr. Rahnama: I strongly believe an informed patient can help the surgeon help them by developing protocols that are specific for them and their needs. If they feel they don’t have the upper body strength, for example, to stay on crutches and remain non-weight-bearing, they should share that with their doctor - and so that we can work with our physical therapy colleagues to help them gain the upper body strength, for example, to then get them ready for lower extremity surgery so that they can stay off of it. It’s not just about doing our portion of the procedure and then having patients go out and be on their own. We want to avoid that as much as possible. So, certainly in my exam, I try to assess the patient’s whole body to make sure that they have that ability, if they’re overweight, or have other things that impede them to remain non-weight-bearing, I definitely try to address that. But, we definitely want to encourage our patients to be forthcoming with any reservations or any concerns that they might have so that they can help us help them. Host: What does recovery after surgery entail? Dr. Rahnama: Typically, a period of non-weight-bearing for 2 to 3 weeks. And I will say that these protocols vary sometimes between surgeons. But there is research now that shows that the quality of new collagen that your body puts down when repairing ligaments depends on the stress being put on them. This is very similar to what we’ve known for a very long time about bone healing and bone turnover in your body. The stress of gravity and the stress of weight bearing actually helps your body heal it the way that it should be healed. And so, after a short period of non-weight-bearing, and making sure that our incisions are healed, I get my patients to therapy as soon as I can right after that to make sure that they engage them with a week to two of fairly aggressive, non-weight-bearing exercises. And then, in under a month typically, I will try to get my patients weight bearing again, again with the help of our physical therapy colleagues, to get them back on their feet and to make sure they have the best outcomes possible. Host: What are some of those exercises that your patients are participating in during that initial couple of weeks and then the following month? Dr. Rahnama: So, a lot of them might be resistance exercises, proprioceptive exercises, exercises that really strengthen the muscles, the tissues around the foot and the ankle and to really be able to support the repair that we’ve done. So, collagen are the little building blocks of ligaments and connective tissues in our body. And so, anytime you have an injury to the soft tissues and ligaments included in that, collagen is what your body uses to help repair things. Host: Could you tell us about a patient who had foot or ankle surgery after a bad sprain and was able to return to an active lifestyle? Dr. Rahnama: I had a college athlete in her twenties last year who had been spraining since she could remember and now it was getting to the point that, even with the best wrapping by her trainers, she couldn’t do what she wanted to do. So, she came and saw us. Obviously, being an athlete, she had some great trainers and therapists trying to rehab her with no good results. So, we proceeded to surgically fix the ankle ligaments, utilizing a minimally invasive technique and arthroscopy, where we make small incisions, just millimeters wide, and place a small camera into the joint and use that to help guide our repair. Surgery went as planned and we proceeded to use her training team again to help us get her back. And, she was back training in under two months, without restrictions. Now, she’s an extreme case of very aggressive rehab, but the point is that it can be done and there’s no reason to think that even the most physically demanding athletes can’t get back on their feet and get back to doing what they love. Host: I know a lot of folks can be kind of stubborn when it comes to thinking about surgery. What are some of the reasons that you would give patients if they’re hesitant to come have surgery because they don’t want to take time off their activities? Dr. Rahnama: That’s a great question. The one thing that I would emphasize is that a small problem, if not addressed by the right specialist, can a lot of times turn in to a much larger problem down the road that the patient then can’t avoid having taken care of. If a patient doesn’t see somebody for a chronic ankle sprain and thinks that this is something that they don’t want to have addressed, the reality is if they DO have it addressed and they have a small procedure now, that may help them avoid a much larger procedure, such as the need for a total joint replacement or joint fusion even, later on in the future as they get older. Host: Why should someone with chronic ankle pain or a bad sprain speak to a surgeon at MedStar Washington Hospital Center? Dr. Rahnama: We’re here to help and make sure our patients and individuals suffering from foot and ankle conditions can get back to life and do the things they love and be active. And so, that’s what we do every day, and we just want to make sure the local public knows we’re here, and if they need us, we’re happy to help. Host: Thanks for joining us today, Dr. Rahnama. Dr. Rahnama: Thank you so much for having me. Conclusion: Thanks for listening to Medical Intel with MedStar Washington Hospital Center. Find more podcasts from our healthcare team by visiting medstarwashington.org/podcast or subscribing in iTunes or iHeartRadio.

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Looking After Your New Tattoo

Inform Podcast

Play Episode Listen Later Mar 7, 2019

Our Story – Support Us – Annual Report – Corporate Snapshot – Research Partners – Our Supporters Health Information – Brochures – Inform – Podcast – Read – Learn Hub – Resources Funding Schemes Services – NDIS – Personal Care – Domestic Assistance – Sleepovers – Meal Preparation Assistance – Community Access Services – Complex Care Supports & Solutions – Health & Well-being Programs – Support Groups – Psychology & Counselling Shop – Shop Healthcare Products – Shop Mobility Aids Contact Us Looking After Your New Tattoo Did you know your fresh tattoo is essentially a wound? And just like any other wound, your new ink requires specific care to successfully complete the healing process and avoid infection. Our nurse has answered the top 5 questions for looking after your new ink: 1. How long does a fresh tattoo take to heal? 2 – 6 weeks is the average time. However, the exact healing time can be dependent on the size and design. 2. Is Bepanthen the best antiseptic ointment to use? Bepathen is a popular antiseptic ointment choice. However, other antiseptic ointments include Savlon and Soov. Any of the three can be used on new ink once gently cleaned with a combination of antimicrobial soap and lukewarm water. 3. How important is aftercare? Very important. The aftercare you provide is crucial to preventing infection, removing blood residue and preserving the design you have chosen. 4. What should I avoid during the healing process of my tattoo? Whilst fully healed tattoos are resistant to most activities, new designs should be handled with care and the following avoided until the healing process has taken place. > Touching your tattoo with unwashed hands. This also includes letting anyone else touch it.> Washing the area with extremely hot water or harsh cloths.> Shaving the area in which your tattoo is placed> Wear tight-fitting or any other clothing garments which are likely to rub against your tattoo. 5. Once my tattoo has healed, is there anything I need to do? Once the healing process has taken place your design will still be very fresh and will, therefore, require protection against the sunlight. Always Cover your tattoo in a high SPF sunscreen when exposure to sunlight is likely to occur. Gentle high SPF sunscreen options include; SunSense Sensitive or SunSense Daily Face. Looking for a step by step guide to aftercare? More Wound Care Advice From looking after a new wound to how to store wound care products, check out our wide range of health tips from leading health professionals. What is Wound Debridement? Wound care articlesWhat is Wound Debridement? Debridement is a French word that literally means “to remove constraints”. In the case of a wound and wound debridement, constraints may be due to necrotic, or dead tissue. This type of tissue has little to no blood supply and as such,... How wellbeing affects wound care Wound care articlesSmith + Nephew are a leading portfolio medical technology company and they have some advice about wellbeing and wound care. Lacerations & Abrasions Wound care articles Lacerations & AbrasionsThe Skin The skin is the largest organ of the body, and it is the first line of defense against disease and any breach in skin integrity has the potential to develop an infection1. The skin has several important functions, it protects the...

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Episode 24: The Emerging Science of Biofilm Debridement

Play Episode Listen Later Jan 30, 2019 17:29

Typically, when patients present to a wound clinic, they have been experiencing their chronic wound(s) for a substantial amount of time. For the wound care clinician, biofilm presents an obstacle in helping the patient to achieve rapid wound closure. The more realistic of a timeline that is shared with patients, the more optimistic they are likely to be. In this podcast episode, Today’s Wound Clinic continues its series on “The Emerging Science of Biofilm Debridement.” Featuring guests Dr. Matthew Myntti, PhD, chief technology officer at Next Science, and Patricia Stevenson, MSN, ACNS-BC, CWS, clinical consultant at Next Science. Hosted by Stephen G. Bergquist, MD, CWSP

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Episode 24: The Emerging Science of Biofilm Debridement

pregnancy repair wound implants earrings tummy tucks debridement

Play Episode Listen Later Jan 30, 2019 17:29

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Episode 58: implants & pregnancy, earrings after earlobe repair, wound debridement and tummy tuck

Staiano Plastic Surgery

Play Episode Listen Later Jan 15, 2018 18:04

https://www.facebook.com/thestaianoclinic I discuss implants when you get pregnant, wearing earrings after having an earlobe repair, wound debridement and types of tummy tuck.

Episode 11: The Debridement Debate (Part 3)

Play Episode Listen Later Dec 4, 2017 37:04

In this episode, podcast host Stephen G. Bergquist, MD, CWSP, and Shaun Carpenter, MD, FAPWCA, CWSP, finish their discussion on (almost) all parts inherent to the ongoing debate on debridement in wound care.

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Episode 11: The Debridement Debate (Part 3)

Play Episode Listen Later Dec 4, 2017 37:04

debate md wounds wound care debridement cwsp

Episode 10: The Debridement Debate (Part 2)

Play Episode Listen Later Sep 29, 2017 42:42

In this episode, podcast host Stephen G. Bergquist, MD, CWSP, and Shaun Carpenter, MD, FAPWCA, CWSP, continue their discussion on (almost) all parts inherent to the ongoing debate on debridement in wound care.

Episode 9: The Debridement Debate (Part 1)

Play Episode Listen Later Sep 29, 2017 30:57

In this episode, podcast host Stephen G. Bergquist, MD, CWSP, discusses (almost) all parts inherent to the ongoing debate on debridement that pervades the wound care industry.

Episode 9: The Debridement Debate (Part 1)

Play Episode Listen Later Sep 29, 2017 30:57

In this episode, podcast host Stephen G. Bergquist, MD, CWSP, discusses (almost) all parts inherent to the ongoing debate on debridement that pervades the wound care industry.

Episode 10: The Debridement Debate (Part 2)

Play Episode Listen Later Sep 29, 2017 42:42

Special Operations Medical Association

26: ICRC Style Wound Care

Play Episode Listen Later Aug 11, 2017 18:52

Version:1.0 StartHTML:000000313 EndHTML:000022696 StartFragment:000021664 EndFragment:000022613 StartSelection:000021664 EndSelection:000022613 SourceURL:https://prolongedfieldcare.org/2017/08/11/podcast-episode-25-advanced-icrc-wound-care-and-the-acute-wound-care-management-clinical-practice-guideline/ Podcast Episode 25: ICRC Style Wound Care and the NEW Acute Wound Care Management Clinical Practice Guideline â€“ ProlongedFieldCare.org This Clinical Practice Guideline was written by a fellow 18D with input from around the surgical community. Â It reconciles the differences between wound care done in a role 2 or 3 facility, such as serial debridements, with what is taught in the 18D Special Forces Medical Sergeant Course with regards to delayed primary closure. Â One way is not â€œrightâ€ while the other wrong, it has more to do with the amount of time and resources available to the medic or other provider. Â The remainder of the blog post and podcast is meant to be a refresher for those who have already been taught these procedures. Â It is also meant to be informational for those medical directors who may not be exactly certain of what has been taught as far as wound care and surgery.Â Â If you havenâ€™t been trained to do these procedures before going ahead with them, it is very likely that you may do more harm to the patient than good.

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Survival Medicine Hour: Shock, Wound Debridement, More

Play Episode Listen Later Jul 7, 2017 56:00

In this episode of The Survival Medicine Hour, Joe and Amy Alton, aka Dr. Bones and Nurse Amy, discuss the Wilderness Medical Society's special edition on combat casualty care guidelines applied to survival settings, where they coincide and where they diverge. Also, some basics on an important part of wound care, wound debridement, the removal of dead skin from a healing open wound. Also, more on the different types of shock, and what to do if you have to treat someone deteriorating rapidly from one of the various types. All this and more on the latest Survival Medicine Hour with JOe Alton MD, and Amy Alton ARNP!

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Survival Medicine Hour: Shock, Wound Debridement, More