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In this lighthearted yet clinically valuable episode of The Full Arch Podcast, Dr. Steven Vorholt and Dr. Aaron Miller kick things off with some April Fools banter, including a hilarious (and slightly terrifying) prank involving Locator Fixed. But beyond the laughs, they tackle an important listener question: What's the best way to treat full-arch patients with active periodontal disease and poor hygiene? The docs dive into practical advice for handling tough full-arch cases—from flap design and irrigation to communication strategies and knowing when immediate treatment is actually better than delaying.
On this episode of the AMSSM Sports Medcast (X: @TheAMSSM), host Dr. Jeremy Schroeder, MD, is joined by Dr. Ashwin Rao, MD, to provide a preview of his main stage presentation about Microsurgical Tendon Debridement vs. Orthobiologics for Tendinopathy during the 2025 AMSSM Annual Meeting. Dr. Rao is board certified in family medicine and sports medicine, and is a Professor in UW School of Medicine's Department of Family Medicine. He is also a team physician for University of Washington Husky Athletics and a medical consultant for the Brooks Beast Middle Distance Track Club. He previously served as a team physician for the NFL's Seattle Seahawks, Program Director of the UW Primary Care Sports Medicine Fellowship, and Co-Chair of the Education Committee on the Board of Directors of the American Medical Society for Sports Medicine (AMSSM). In-person and virtual attendance options are still available for the conference. Register to attend the 2025 AMSSM Annual Meeting at annualmeeting.amssm.org.
On this episode of the AMSSM Sports Medcast (X: @TheAMSSM), host Dr. Jeremy Schroeder, DO (X: @thejschro), is joined by Dr. Ashwin Rao, MD, to provide a preview of his main stage presentation about Microsurgical Tendon Debridement vs. Orthobiologics for Tendinopathy during the 2025 AMSSM Annual Meeting. Dr. Rao is board-certified in family medicine and sports medicine, and is a Professor in UW School of Medicine's Department of Family Medicine. He is also a team physician for University of Washington Husky Athletics and a medical consultant for the Brooks Beast Middle Distance Track Club. He previously served as a team physician for the NFL's Seattle Seahawks, Program Director of the UW Primary Care Sports Medicine Fellowship, and Co-Chair of the Education Committee on the Board of Directors of the American Medical Society for Sports Medicine (AMSSM). In-person and virtual attendance options are still available for the conference. Register to attend the 2025 AMSSM Annual Meeting at annualmeeting.amssm.org.
What role does bioresorbable packing play in improving outcomes for ENT patients? In this episode of BackTable ENT, hosts Dr. Ashley Agan and Dr. Gopi Shah are joined by Dr. Satyan Sreenath, a rhinologist at Indiana University, to discuss the use of bioresorbable packing in ENT surgeries. --- SYNPOSIS First, Dr. Sreenath offers insights into the advancements in sinus and skull base surgery, the types of packing materials available (such as HemoPore, NasoPore, and chitosan-based products), and their application for hemostasis, scar prevention, and patient comfort. The surgeons emphasize the importance of tailored postoperative care and use of nasal irrigations and debridements to optimize healing and surgical results. Dr. Sreenath also mentions the evolving field of drug delivery through bioresorbables and the benefits of exploring new technologies to enhance patient outcomes. --- TIMESTAMPS 00:00 - Introduction 01:53 - Bioresorbables for the Nose 06:44 - Patient Comfort and Postoperative Care 20:18 - Packing Techniques 24:52 - Chitosan-Based Products 32:51 - Techniques for Debridement & Postoperative Management 42:40 - Skull Base Surgery Considerations 55:25 - Nosebleeds and Emergency Care 01:02:05 - Complications and Innovations 01:07:40 - Conclusion --- RESOURCES Dr. Sreenath's IU profile https://iuhealth.org/find-providers/provider/satyan-b-sreenath-md-1821999 BackTable+ for ENT https://plus.backtable.com/pages/ent Check out BackTable+ for ENT, our sponsor and new e-learning platform! https://plus.backtable.com/pages/ent
Join us as Leigh Poland talka about her article in the November AAPC Magazine, High-Risk Debridement Coding and Documentation. Kathrine Abel from AAPC's content team also joins the broadcast to share updates on AAPC's education and exams.
Get ahead with VETAHEAD and join Dr. Proença on 15 minutes of ZooMed (exotic animal medicine) content. Today, Dr. Proença dives into the latest research on treating odontogenic abscesses and jaw osteomyelitis in rabbits, revealing why radical debridement and frequent monitoring is the key to success. From the importance of comprehensive surgical techniques to the crucial role of client follow-up, this episode is packed with practical insights for veterinary professionals. If you're dealing with stubborn odontogenic abscesses and complex osteomyelitis, these findings will revolutionize your approach to rabbit care. Tune in and get ready to elevate your practice! Click here to receive a VETAHEAD Gift! Do you want to access more ZooMed (exotics) knowledge directly from specialists? Come with us and #jointhemovement #nospeciesleftbehind Head to VETAHEAD Website Join our VETAHEAD Community Follow @the_vetahead on Instagram Subscribe to @vetahead channel on YouTube Follow @vetahead on Facebook Follow @vetahead on TikTok
In this episode, host Alyssa Watson, DVM, welcomes back DJ Haeussler, DVM, MS, DACVO, to talk about his recent Clinician's Brief article, “Diamond Burr Debridement for Indolent Corneal Ulcers.” Dr. Haeussler starts by reviewing all the practical details about indolent ulcers, including how to diagnose them and initiate treatment. Then, for the cases that don't respond, he explains when and how to perform diamond burr debridement using a dental handpiece.Resource:https://www.cliniciansbrief.com/article/corneal-ulcers-erosion-treatment-corneaContact:podcast@vetmedux.comWhere To Find Us:Website: CliniciansBrief.com/PodcastsYouTube: Youtube.com/@clinicians_briefFacebook: Facebook.com/CliniciansBriefLinkedIn: LinkedIn.com/showcase/CliniciansBrief/Instagram: @Clinicians.BriefX: @CliniciansBriefThe Team:Alyssa Watson, DVM - HostAlexis Ussery - Producer & Multimedia Specialist
Down the Rabbit Hole with AEMV: Exotic Companion Mammal Briefs
Dr. Vladimir Jekl DVM, PhD, DipECZM (S. Mammal) chats with us about dental abscesses in rabbits and his 2023 retrospective review JAVMA paper that included 200 cases. In it, we discuss:where do these abscesses come from, anyways?can you culture things from a rabbit abscess?what are the most common complications he sees?And more.
Dr. Najia Usman graduated from SUNY Buffalo in 1995 with her DDS. After completing a one-year general practice residency at the Cleveland Clinic she furthered her interest in endodontics by completing a two-year endodontic residency at Oregon Health and Sciences University, Portland, Oregon in 2002. She was awarded her Diplomate Status by the American Board of Endodontics in 2009. Dr. Usman has been in private practice since 2002. Though she practices full-scope endodontics, she has cultivated an interest in the endodontic management in trauma, pediatrics and resorptive lesions. She has organized and lectured in dental trauma symposiums. She has lectured and clinically taught dental students, endodontic and pediatric residents. She has lectured nationally and locally to study clubs on topics such as Endo-Perio, Atypical Facial Pain, Regenerative Endodontics and Pulpal injuries after Oro-Facial Trauma. Her study The Influence of Instrument Size on Debridement was published in the Journal of Endodontics (Feb 2004, vol 30, 110-112) has been cited over 260 times. She is the proud mother of 4 children ages 18 to 28 and has been married to and shares a private multi specialty practice with Dr. Faisal Quereshy OMFS for 29 years. They reside in Cleveland, Ohio.
Get ready to embark on a captivating journey through the pages of military medicine history as we speak with retired Army Colonel Dr. Evan Renz on WarDocs. Dr. Renz, a seasoned General/Trauma Surgeon and Burn Specialist with a rich trove of experience unfolds the evolution of military wound care from the era of World War II to the present day. As we trace the progression from hemorrhage control and debridement to advancements in medications, Damage Control concepts, and the use of innovative wound care technologies, Dr. Renz champions the importance of learning from our past and integrating these lessons into future military medical training. Drawing from his first-hand experience, Dr. Renz guides us through the intricate landscape of wound management in damage control resuscitation and surgery scenarios. We speak about the world of negative pressure wound therapy, starting from his initial use of a Wound Vac in 1997 to its evolution over the years. Experience the crux of Army Medicine as we venture into the crucial considerations surgeons must take when evaluating wounds where a tourniquet is applied to control bleeding and preserve the patient's hemodynamic stability. Our exploration takes a detour to the US Institute of Surgical Research Burn Center in San Antonio, where Dr. Renz shares his valuable insights on complex burns and wound care management. The discussion reveals intriguing practices such as avoiding prophylaxis antibiotics for isolated burn injuries and the strategic use of negative pressure wound treatment. Learn more about the fine balance of initiating and adjusting fluid for patients, the crucial decision-making process involved in combat wound closure, and the pressing need to pass on knowledge and training in the advances of technology. We guarantee that this episode will leave you with a newfound respect for Military Medicine and those who dedicate their lives to its advancement. So, join us for an eye-opening journey into the world of military medicine with Dr. Renz! Chapters: (0:00:00) - Military Wound Care Evolution (0:13:59) - Wound Management in Damage Control (0:28:44) - Burn Center and Wound Care Management (0:46:13) - Decisions in Combat Wound Closure Chapter Summaries: (0:00:00) - Military Wound Care Evolution (14 Minutes) Retired Army Colonel Dr Evan Renz, a General/Trauma Surgeon with extensive experience in training and working at the US Institute of Surgical Research's Burn Unit in San Antonio, provides insights into the evaluation and treatment of complex wounds. He emphasizes the critical importance of documenting and learning from our past to help prepare us for future conflicts and to make sure that these lessons are included in military medical training opportunities. We discuss the changes in wound management from World War II to today, from the importance of hemorrhage control and debridement to advancements in medications and technologies improving wound care. (0:13:59) - Wound Management in Damage Control (15 Minutes) Dr. Evan Renz discusses the importance of wound management in damage control resuscitation. He shares his experience with his first use of a Wound Vac in 1997 and how the use of negative pressure wound therapy evolved over time. We explore the special considerations surgeons must take when evaluating a wound where a tourniquet is in place and how these decisions can help preserve the patient's hemodynamic stability. (0:28:44) - Burn Center and Wound Care Management (17 Minutes) Dr. Renz explains that isolated burn injuries do not require prophylactic antibiotics; however, traumatic combat wounds should be treated with an initial dose of antibiotics in addition to a Tetanus booster. Dr. Renz shares his experience with the use of the Wound Vac in the Burn Center and the key questions that he would ask when taking calls for burn management care. He also explains the importance of avoiding over-resuscitation and how to initiate and adjust fluid for the patient. Finally, he outlines the care that the patient would receive in regard to their wounds once they reach Role 4 or 5 facilities. (0:46:13) - Decisions in Combat Wound Closure (7 Minutes) Dr. Evan Renz shares his experience with the Emergency War Surgery manuals and the use of Wound Vacs in the field. We also discuss the importance of repeating a primary and secondary survey with each transfer of care and how to identify when a wound can or should be closed primarily or covered by a flap or graft. Finally, Dr. Renz speaks to the importance of passing on knowledge and training in the advances of technology so that it is not forgotten. Take Home Messages: Military medicine has evolved significantly from the World War II era to the present day, highlighting the importance of learning from the past to enhance future medical training. Advances in medications and wound management techniques, such as leaving more wounds open and exteriorizing the bowel for abdominal injuries, have marked significant milestones in military medicine. Negative pressure wound therapy has seen remarkable evolution over the years and plays a crucial role in wound management in damage control resuscitation. Surgeons need to make critical considerations when evaluating a wound downstream from a tourniquet in order to preserve the patient's hemodynamic stability. Burn centers play a crucial role in wound care management, with innovative practices like avoiding prophylaxis antibiotics for isolated burn injuries and the strategic use of wound vac. Adjusting and initiating fluid for patients and making critical decisions on combat wound closure are part of the complex process in wound care management. Knowledge and training in technological advances in wound care need to be passed on to future generations to ensure continuous improvement. Initial wound care at the point of injury prioritizes hemorrhage control, as highlighted by the TCCC guidelines. Wound management in damage control resuscitation involves the careful evaluation and treatment of wounds and extensive documentation of each treatment process to guide subsequent care. Wound care management, especially in a resource-limited setting, requires a practical approach, including bedside care, ensuring proper lighting and pain control. Episode Keywords: Military Medicine, Wound Care, Damage Control, Burn Center, Wound Management, Negative Pressure Wound Therapy, Tourniquet, Hemodynamic Stability, Prophylaxis Antibiotics, Image Control, Debridement, Fluid Management, Combat Wound Closure, War Surgery, Wound Vac, Technology Training Hashtags: #wardocs #military #medicine #podcast #MilMed #MedEd #MilitaryMedicine #CombatWoundCare #DrEvanRenz #WarDogsPodcast #MedicalEvolution #MilitaryTraining #BurnInjuries #DamageControlResuscitation #WoundVacTherapy #BattlefieldMedicine Honoring the Legacy and Preserving the History of Military Medicine The WarDocs Mission is to honor the legacy, preserve the oral history, and showcase career opportunities, unique expeditionary experiences, and achievements of Military Medicine. We foster patriotism and pride in Who we are, What we do, and, most importantly, How we serve Our Patients, the DoD, and Our Nation. Find out more and join Team WarDocs at https://www.wardocspodcast.com/ Check our list of previous guest episodes at https://www.wardocspodcast.com/episodes Listen to the “What We Are For” Episode 47. https://bit.ly/3r87Afm WarDocs- The Military Medicine Podcast is a Non-Profit, Tax-exempt-501(c)(3) Veteran Run Organization run by volunteers. All donations are tax-deductible and go to honoring and preserving the history, experiences, successes, and lessons learned in Military Medicine. A tax receipt will be sent to you. WARDOCS documents the experiences, contributions, and innovations of all military medicine Services, ranks, and Corps who are affectionately called "Docs" as a sign of respect, trust, and confidence on and off the battlefield, demonstrating dedication to the medical care of fellow comrades in arms. Follow Us on Social Media Twitter: @wardocspodcast Facebook: WarDocs Podcast Instagram: @wardocspodcast LinkedIn: WarDocs-The Military Medicine Podcast
October 13, 2023 Ray, Mark, and Scott discuss questions from the Urology Coding and Reimbursement Group.Are injections like Lupron and Prolia and the administration given by an advanced practice provider subject to the 85% reimbursement or are these reimbursed at 100% even if given by a nurse practitioner?Are 11006 and 97606 appropriate here for wound vac?OPERATION: Debridement of Fournier's gangrene.DRAINS: Wound VAC, 16-French Foley catheter.OPERATIVE TECHNIQUE: The patient was brought into the operating room, placed in supine position on the operating room table. After administration of IV antibiotics and anesthesia, the patient was repositioned in dorsal lithotomy position, prepped and draped in the usual sterile fashion. The wound measured approximately 30 cm x 14 cm and went from the left inguinal region through the left perineum and to the posterior left buttocks. Using a curettage, we proceeded with additional debridement of all the raw surfaces. Spot electrocautery was used as needed for hemostasis and the wound was irrigated copiously with antibiotic irrigation. The sharp debridement was done to the level of the dartos fascia and Colles fascia. Once we had finished the sharp debridement, we went ahead and decided to place a wound VAC. A black sponge was placed into the wound and then carefully placed using the sticky plastic and put it to suction. Given the location, it was a bit challenging but we were able to place the wound VAC to suction. Given that the wound extended near the posterior buttocks, it was near the anus which would likely be an issue for maintaining suction if the patient had a bowel movement. The patient tolerated the procedure well.Mark Painter and PRS ConsultingSchedule a call with Mark Painter / PRS ConsultingUrology Documentation, Coding, and Billing CertificationFor Urologists and APPs (Click Here for Pricing, More Information, and Registration)Documentation, Coding, and Billing Fellowship - Urology (DCB-FS) For Coders, Billers, and Admins (Click Here for Pricing, More Information, and Registration)Documentation, Coding, and Billing Specialist Certification (DCB-SC)Documentation, Coding, and Billing Master Certification (DCB-MC)Urology Advanced Coding and Reimbursement Seminar(Click Here for More information and Registration) Las Vegas, December 1 & 2, 20238 am - 4:30 pm Friday, 8 am - 3:30 pm SaturdayNew Orleans, January 26 & 27, 20248 am - 4:30 pm Friday, 8 am - 3:30 pm SaturdayReserve your spot and save!As a Urology Coding and Reimbursement Podcast listener, you get access to a discount (expires 8/31/23).Use code: 24UACRS733Get signed up today and get peace of mind knowing you will be prepared for all the upcoming changes.The Thriving Urology Practice Facebook group.The Thriving Urology Practice Facebook Group link to join:https://www.facebook.com/groups/ThrivingPractice/ Join the discussion:Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.Click Here to Start Your Free Trial of AUACoding
Dr. Adolph Lombardi leads discussion on Partial Radical Debridement in Infected THA. Drs. Wayne Paprosky and Steven Haas present their views in the table discussion followed by comments from attendees. Thanks to OsteoRemedies for sponsoring this episode. To learn more, visit OsteoRemedies.com To see the images and case presentation information while you listen, download the ConveyMED App for free: Apple Store click here Google Play click here Thank you for listening to our podcasts. As a token of appreciation, The Hip Society and The Knee Society are excited to offer you a 23% discount on CCJR 2023 meeting registration across all registration categories if you register before 11/1/2023. Please visit https://ccjr.com/ccjr-2023/ and apply the following discount code: SHAK23 at checkout.
Military Medicine & WarDocs present: "A Ready Medical Force Special Collection" MILMED-D-22-00154: “Ascertaining the Readiness of Military Orthopaedic Surgeons: A Revision to the Knowledge, Skills, and Abilities Methodology” EPISODE SUMMARY Discover the crucial factors for Military Orthopedic Surgeon readiness in our thought-provoking discussion with retired Air Force Colonel and Orthopedic Trauma Surgeon, Dr. Patrick Osborn. Together, we explore the updated revision of the Knowledge, Skills, and Abilities (KSA) methodology, examining the KSA project's concerning findings and the process of generating KSA scores to measure readiness in Military Medicine. We also discuss ways to eliminate and realign CPT codes for a more accurate assessment of Military Orthopedic Surgeon readiness. We dive deeper into the challenges of integrating high-acuity cases from trauma centers into military treatment facilities (MTFs) and how off-duty employment data can be unreliable. Dr. Osborn shares insights on the KSA project's measurement of reps and procedures deemed important and ways to evaluate surgeon competence beyond CPT codes. Our conversation highlights the significance of military medical training, especially in the area of wound debridement, and the roles experience and confidence play in decision-making. Lastly, we emphasize the need for readiness training for medical personnel and the importance of team experience in developing a Ready Medical Force. Dr. Osborn stresses the necessity for local community buy-in and commitment to supporting an ACS-designated trauma center. Join us in this vital conversation as we uncover the key aspects of improving Military Orthopedic Surgeon readiness and ensuring the competence of our medical forces in times of crisis. EPISODE CHAPTERS (0:00:01) - Improving Military Orthopedic Surgeon Readiness (0:09:04) - Military Facility Readiness & Surgeon Competency (0:17:33) - Building a Ready Medical Force (0:24:18) - Future Improvements EPISODE CHAPTER SUMMARIES (0:00:01) - Improving Military Orthopedic Surgeon Readiness (9 Minutes) Col(R) Patrick Osborn, MD discusses his Military Medicine paper: “Ascertaining the Readiness of Military Orthopaedic Surgeons: A Revision to the Knowledge, Skills, and Abilities Methodology” He discusses why the KSA project's findings were concerning; the process by which KSA scores are generated and used to measure readiness in Military Medicine; and how to decide which CPT codes to eliminate and realign to better measure the readiness of Military Orthopedic Surgeons. (0:09:04) - Military Facility Readiness & Surgeon Competency (8 Minutes) We discuss the difficulties of bringing high acuity cases from trauma centers into MTFs and how data can be unreliable regarding off-duty employment and moonlighting. We also look at the KSA project and how it measures the number of reps or procedures deemed important, and how we can measure the competence of surgeons beyond the number of CPT codes generated over a period of time (0:17:33) - Building a Ready Medical Force (7 Minutes) Dr. Osborn explains the importance of focused military medical training, particularly in the area of wound debridement after combat injuries. We discussed the need to do simple procedures well and how experience and confidence play a role in decision-making. We also discussed the need for readiness training for medical personnel and the importance of team experience in developing a Ready Medical Force. Lastly, we discussed the need for local community buy-in and commitment to support a trauma center. (0:24:18) – Future Improvements (1 Minute) We discussed the challenges of bringing high acuity cases from trauma centers into MTFs and how data can be unreliable regarding off-duty employment. We also discussed the need to update the Knowledge-Based Learning System to include the latest developments in trauma medicine. EPISODE KEYWORDS Military Orthopedic Surgeon Readiness, KSA Methodology, CPT Codes, Trauma Centers, MTFs, Off-Duty Employment, Reps and Procedures, Debridement, Readiness Training, Team Experience, Local Community Buy-In, Knowledge-Based Learning System, Trauma Medicine #Military #Medical #Podcast #WarDocs #Orthopedics #Surgeon #SurgicalTeams #MilitaryMedicine #Readiness #Training #Knowledge #Skills #Abilities #KSAs Honoring the Legacy and Preserving the History of Military Medicine The WarDocs Mission is to improve military and civilian healthcare and foster patriotism by honoring the legacy, preserving the oral history, and showcasing military medicine career opportunities, experiences, and achievements. Find out more and join Team WarDocs at https://www.wardocspodcast.com/ Check our list of previous guest episodes at https://www.wardocspodcast.com/episodes Listen to the “What We Are For” Episode 47. https://bit.ly/3r87Afm WarDocs- The Military Medicine Podcast is a Non-Profit, Tax-exempt-501(c)(3) Veteran Run Organization run by volunteers. All donations are tax-deductible, and 100% of donations go to honoring and preserving the history, experiences, successes, and lessons learned in military medicine. A tax receipt will be sent to you. WARDOCS documents the experiences, contributions, and innovations of all military medicine Services, ranks, and Corps who are affectionately called "Docs" as a sign of respect, trust, and confidence on and off the battlefield, demonstrating dedication to the medical care of fellow comrades in arms. Follow Us on Social Media Twitter: @wardocspodcast Facebook: WarDocs Podcast Instagram: @wardocspodcast LinkedIn: WarDocs-The Military Medicine Podcast
The ministry of Jesus revealed God's love and goodwill for mankind and creation at large. Discover the mystery behind the miracle of the feeding of the 5000 and the miracle of resurrection; your Christian walk will take on new colors as you come into contact with these divine realities. God bless you as you watch!
Have you read the parable of the ten virgins in the Bible or have you heard sermons of this Bible passage? If you have, has it ever bothered you into which group you belong: to the wise virgins or the fools. Pastor Obed brings clarity regarding the meaning of the parable to clear away all the misunderstanding that abounds. You will be enlightened as you watch! GOD BLESS YOU!
Five articles from the March 2023 issue summarized in five minutes, with the addition of a brief editorial commentary. The 5-in-5 feature is designed to give readers an overview of articles that may pique their interest and encourage more detailed reading. It may also be used by busy readers who would prefer a brief audio summary in order to select the articles they want to read in full. The featured articles for this month are, “Predictors of Return to Work Following Primary Arthroscopic Rotator Cuff Repair: An Analysis of 1502 Cases,” “Aragonite-Based Scaffold Versus Microfracture and Debridement for the Treatment of Knee Chondral and Osteochondral Lesions: Results of a Multicenter Randomized Controlled Trial,” “Disagreement Between the Accepted Best-Fit Circle Method to Calculate Bone Loss Between Injured and Uninjured Shoulders,” “Clinical Outcomes After Ulnar Collateral Ligament Reconstructions With Concomitant Ulnar Nerve Transposition in Overhead Athletes: A Matched Cohort Analysis,” and “Effect of Posterior Malleolar Fixation on Syndesmotic Stability.” Click here to read the articles.
In this podcast, Dr. Laura Swoboda DNP, APNP, FNP-BC, CWOCN-AP, discusses why a clinician should debride, what types of patients a clinicians shouldn't be debriding, and when to use non-instrument debridement.
On Election Day, Question #2 in Massachusetts easily passed. Medical loss ratio (MLR) is a hot topic right now but what is it and will the bill have the desired effect on the market? Time will tell. Also, debridement is a hot topic nowadays. I know, exciting! The code is being tweaked for 2023. I discussed the myths around D4355 and what the revision means for your schedule. CORRECTION: Thanks to Dr. W for letting me know that local factors are plaque and calculus. I had localized in my head. Sorry for the confusion! Resources from the show: Insurance Extravaganza 2023: THE Dental Revenue Cycle Conference Use “teresa” for $100 courtesy! 2023 Coding Update Webinar Policy paper from Tufts regarding Question 2 Full show notes on the podcast home page! https://nobodytoldmethat.libsyn.com/ Don't forget to check out my other podcast Chew on This - A Dental Podcast! **If you like the show then I'd appreciate a good rating. Tell your friends. Even podcasters ask for referrals!** Teresa's Website- https://www.odysseymgmt.com/ (sign up for my newsletter!) Teresa's Book Moving Your Patients to Yes! Easy Insurance Conversatio
How do you use the debridement code? Are you operating under an old-school train of thought? Join Andrew and Erika Flateau, RDH, to discuss codes and how Andrew and Erica use them in the clinic. They dive into debridement codes, D4346, and communicating with patients about the procedures you perform. Reach Erika: erikaflateau@gmail.com www.renewconsultingservices.com
How do you use the debridement code? Are you operating under an old-school train of thought? Join Andrew and Erika Flateau, RDH, to discuss codes and how Andrew and Erica use them in the clinic. They dive into debridement codes, D4346, and communicating with patients about the procedures you perform. Reach Erika: erikaflateau@gmail.com www.renewconsultingservices.com
How will Lonzo Ball's arthroscopic debridement impact his season? How will this impact the Bulls long-term? K.C. Johnson, Jason Goff, and Tony Gill discuss your Twitter submitted questions on Ball in this mailbag episode. The guys also discuss where they see the Bulls landing in the Eastern Conference, what they expect from Patrick Williams headed into his 3rd year, and a lot more.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.
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!
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
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.
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
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/
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/
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...
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
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.
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
In this podcast, Dr. Laura Swoboda DNP, APNP, FNP-BC, CWOCN-AP, discusses why a clinician should debride, what types of patients a clinicians shouldn't be debriding, and when to use non-instrument debridement.
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
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..
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.
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
-----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
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.
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!
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!
SCORE Modules Covered: Diseases/Conditions: Pancreatitis - Acute/Pancreatic Necrosis/Abscess (Core), Operations/Procedures - Pancreatic Debridement (Core)
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/
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.
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...
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
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
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.
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.
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.
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.
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.
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.
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.
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 – ProlongedFieldCare.org This Clinical Practice Guideline was written by a fellow 18D with input from around the surgical community.  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.  One way is not “right†while the other wrong, it has more to do with the amount of time and resources available to the medic or other provider.  The remainder of the blog post and podcast is meant to be a refresher for those who have already been taught these procedures.  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.  If you haven’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.
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!
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!
Five articles from the February 2016 issue summarized in five minutes, with the addition of a brief editorial commentary. The 5-in-5 feature is designed to give readers an overview of articles that may pique their interest and encourage more detailed reading. It may also be used by busy readers who would prefer a brief audio summary in order to select the articles they want to read in full. The featured articles for this month are “Arthroscopic Stabilization of Chronic Acromioclavicular Joint Dislocations: Triple- Versus Single-Bundle Reconstruction”, “Immobilization in External Rotation Versus Internal Rotation After Primary Anterior Shoulder Dislocation: A Meta-analysis of Randomized Controlled Trials”, “Effect on Patient-Reported Outcomes of Debridement or Microfracture of Concomitant Full-Thickness Cartilage Lesions in Anterior Cruciate Ligament–Reconstructed Knees: A Nationwide Cohort Study From Norway and Sweden of 357 Patients With 2-Year Follow-up”, “Anterior Cruciate Ligament Injuries in Professional Hockey Players”, and “Individualizing the Tibial Tubercle– Trochlear Groove Distance: Patellar Instability Ratios That Predict Recurrent Instability”. Click here to read the articles.
Medizinische Fakultät - Digitale Hochschulschriften der LMU - Teil 15/19
Die Rotatorenmanschettenläsion, ihre Diagnostik und Therapie wurde erstmals umfas-send 1934 von Codman beschrieben (Codman 1934). Seitdem hat sich eine differenzierte Betrachtungsweise durchgesetzt. Die verschiedenen Rissformen und Rissgrössen bestimmen unter anderem, welche Behandlungsform welchem Patienten zuteil wird. Wichtige Kriterien sind ausserdem der Grad der Sehnenretraktion, der Grad der Muskelatrophie und Verfettung sowie der akromiohumerale Abstand.
Medizinische Fakultät - Digitale Hochschulschriften der LMU - Teil 09/19
Das Pyoderma gangränosum (PG)ist eine seltene, immunologisch bedingte, ulzerierende Hauterkrankung ungeklärter Genese. Zur Therapie wird eine alleinige immunsuppressive Therapie empfohlen und allgemein von einer chirurgischen Therapie aufgrund der Gefahr einer Pathergie abgeraten. Wir untersuchten 14 Patienten mit fortgeschrittenem PGdie mit einer kombinierten Therapie aus Immunsuppression, chirurgischen Debridement, VAC-Therapie und Spalthauttransplantation. Wir konnten zeigen das diese Therapie bei 12 von 14 Patienten in durchschnittlich 108 Tage zur Abheilung der Ulzerationen führte. Das gefürchtete Pathergiephänomen trat nur bei einer Patientin auf, und war auf die frühzeitige Reduktion der Immunsuppression zurückzuführen. Wir konnten zeigen das eine chirurgische Therapie beim fortgeschrittenen PG unter Immunsuppression durchgeführt werden sollte um septischen Komplikationen vorzubeugen.
Medizinische Fakultät - Digitale Hochschulschriften der LMU - Teil 01/19
Die Magnetresonanztomographie wird in der derzeitigen Literatur als diagnostisches Mittel der Wahl bei Pathologien der Rotatorenmanschette und als wichtigstes Diagnostikum in der Evaluation von rekonstruierten Rotatorenmanschetten angesehen. Präoperativ kann die Magnetresonanztomographie Aussagen über die Grösse und Lage der Rotatorenmanschettenruptur und den qualitativen Zustand des Muskel- und Sehnengewebes liefern. In der vorliegenden Arbeit wurden bei 32 in die Studie eingeschlossenen Patienten mit 32 Schultern die kernspintomographisch prognostischen Faktoren ermittelt, welche zusammen mit den erhobenen klinischen und operativen Befunden eine entscheidende Rolle für eine erfolgreiche Rekonstruktion der Rotatorenmanschette darstellen. Im postoperativen Nachuntersuchungszeitraum, der insgesamt acht Monate betrug wurde jeweils drei und acht Monate nach der Operation eine kernspintomographische und eine klinische Kontrolluntersuchung durchgeführt. Durch die detailgetreue Darstellung der gesamten Rotatorenmanschette mittels standardisierter MRT-Aufnahmen kann nicht nur eine exakte Diagnose gestellt werden, sondern z.B. bei grossen RM-Defekten eine direkte therapeutische Konsequenz abgeleitet werden. Bei Massendefekten wird die Abwägung zwischen rekonstruierenden Therapieoptionen (Sehnennaht, Muskeltransposition) und palliativen Massnahmen (arthroskopisches Debridement, Tuberkuloplastik) entscheidend erleichtert. Auch im postoperativen Beobachtungszeitraum stellt die Magnetresonanztomographie ein nichtinvasives, reproduzierbares diagnostisches Mittel von hoher Sensitivität und Spezifität dar, was in dieser Arbeit gezeigt werden konnte. Durch die Anwendung von zwei postoperativen MR-Kontrolluntersuchungen drei und acht Monate nach der Operation konnte so eine Aussage über den Verlauf des Einheilungsprozeßes der rekonstruierten Rotatorenmanschette gemacht werden. Besonders eignet sich die Magnetresonanztomographie im postoperativen Zeitraum zur Differenzierung der Patienten mit Rerupturen von den Patienten mit intakten Rotatorenmanschetten, welche klinisch symptomatisch sind. Dies ist allein durch eine klinische Untersuchung nicht möglich. Die vorliegende Studie zeigte, daß vor allem die ersten Monate nach der Operation eine entscheidende Phase für die Einheilung der rekonstruierten Rotatorenmanschette darstellen. 49 Mit Hilfe der Magnetresonanztomographie können pathologische Veränderungen der Rotatorenmanschette, welche mit klinischen Symptomen einhergehen, als auch morphologische Veränderungen der Gewebe diagnostiziert werden, die noch klinisch asymptomatisch sind. Obwohl diese subklinischen Zustände meist noch keine klinische Relevanz besitzen, sind sie doch von prognostischer Bedeutung für die stufenweise voranschreitende Pathogenese der Rotatorenmanschettenruptur. Die Verwendung von zwei postoperativen Kontroll- untersuchungen drei und acht Monate nach der Operation ermöglicht eine Verlaufsbeobachtung des Einheilungsprozeßes der rekonstruierten Rotatorenmanschette anhand der ermittelten prognostisch wichtigen MRParameter in Korrelation mit den zugehörigen klinischen Befunden. So konnten Rotatorenmanschettenrerupturen im postoperativen Zeitraum frühzeitig erkannt werden und ein weiteres konservatives oder operatives Procedere rechtzeitig festgelegt werden. Ein signifikanter Rückgang der Signalintensität der rekonstruierten Rotatorenmanschette in der T1- und der T2-Wichtung (p