Podcasts about immobilisation

In this episode, we speak with Professor Mark Wilson about the forthcoming SIS trial. This randomised study aims to compare the safety and patient outcomes of the current spinal immobilisation practice versus a more flexible "movement minimisation" approach for suspected spinal injury patients. The findings could inform future clinical guidelines. The main concepts of the trial include assessing if "movement minimisation" is no worse than the current standard "triple spinal immobilisation" for patients suspected of spinal injury in pre-hospital and emergency settings. Current practice of triple spinal immobilisation (rigid board, straps, neck collar) may have potential harms like breathing difficulties, skin/brain injury. Movement minimisation allows more flexibility and comfort, but its safety/efficacy compared to triple immobilisation is unknown. Around 8,316 patients will be randomly assigned to either movement minimisation or triple immobilisation groups. Their neurological function, complications, and long-term well-being will be assessed. The study involved spinal injury and trauma patient groups (ASPIRE, Imperial Trauma PPI) in design, emphasising the need for research before guideline changes. Results will be shared internationally with patients, the public, paramedics, doctors, and nurses through conferences, social media, reports, and publications to inform future NHS guidelines. More information on the trial can be found here: https://warwick.ac.uk/fac/sci/med/research/ctu/trials/sis/ This podcast is sponsored by PAX. Whatever kind of challenge you have to face - with PAX backpacks you are well-prepared. Whether on water, on land or in the air - PAX's versatile, flexible backpacks are perfectly suitable for your requirements and can be used in the most demanding of environments. Equally, PAX bags are built for comfort and rapid-access to deliver the right gear at the right time to the right patient. To see more of their innovatively designed product range please click here: ⁠https://www.pax-bags.com/en/⁠

Was wurde in den vergangenen Jahren nicht über Sinn und Zweck rigider HWS-Orthesen diskutiert? Lange galten Stifnek und Co als fundamentaler Bestandteil aller Patient*innen-Immobilisation. Bis dann in den vergangenen Jahren zunehmend Kritik lauter wurde und insbesondere die Evidenz ein großes Fragezeichen hinter die hart antrainierte Lehrmeinung setzte.Das Ruhigstellen von Traumapatient*innen hat sich im Laufe der Zeit verändert. In wie weit verlassen wir im Jahr 2023 lang bewährte Pfade? Was sprechen die Daten? Und wie müssen wir heute anders agieren als noch vor 10 Jahren? Darüber unterhalten wir uns in dieser Folge mit dem Leiter der Wiener Rettungsakademie, Michael Girsa, der für uns tief in die Literatur abgetaucht ist und uns Antworten zu diesen Fragen gibt.

In this conversation we will examine the recent changes in spinal immobilisation within pre-hospital practice. We will look at the historic literature, prevalence of spinal injury in reality, the RCSEd recommendations, and other international guidelines and also the current practice of C-spine collars and extrication advice. To do this I have Jim Walmsley with me, Jim is a Critical Care Paramedic at South East Coast Ambulance Service NHS Foundation Trust. Jim has a 19-year history with the ambulance service and has focussed his career on clinical practice, research, under-graduate teaching, as well as managerial duties. In the episode we discuss: • The culture and historic research of spinal immobilisation. • Pre-hospital prevalence & cultural shift • What are the main considerations in the pre-hospital phase of care • Pre-hospital assessment (sensitive? Valid?) main information to take note of (MOI & other factors) • Immediate treatment options – to immobilise or not immobilise • Latest recommendations • Seminal cases where the application of the above has worked well • Final thoughts & take-home messages. Some of the references that Jim referred to can be found here: https://fphc.rcsed.ac.uk/media/1757/pre-hospital-spinal-immobilisation.pdf Canadian C spine rules: https://www.sira.nsw.gov.au/resources-library/motor-accident-resources/publications/for-professionals/whiplash-resources/SIRA08109-Canadian-C-Spine-Rule1117-396476.pdf NEXUS guidelines: https://www.ebmedicine.net/media_library/files/Trauma-Imaging-Resuscitation-CD.pdf Accuracy of the Canadian C-spine rule and NEXUS to screen for clinically important cervical spine injury in patients following blunt trauma: a systematic review https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3494329/ My thanks to Jim for an engaging and insightful interview.

Contributor: Aaron Lessen, MD Educational Pearls: Torus (Buckle) fractures are a commonly encountered pediatric fracture pattern Typically presents as wrist pain secondary to a child falling on outstretched hand One edge of the bone “buckles” or bends because children's bones are softer and more pliable Management Older studies have shown that short term immobilization with a velcro splint and primary care follow up is sufficient Recent randomized trial compared immobilization with Velcro splint with as needed wrist support using a gauze wrap No significant differences noted in outcomes between the two cohorts Physicians can consider using an ace or gauze wrap as needed for buckle fracture management along with OTC analgesics for pain management References Asokan A, Kheir N. Pediatric Torus Buckle Fracture. StatPearls. StatPearls Publishing Copyright © 2022, StatPearls Publishing LLC.; 2022.   Kennedy SA, Slobogean GP, Mulpuri K. Does degree of immobilization influence refracture rate in the forearm buckle fracture? J Pediatr Orthop B. Jan 2010;19(1):77-81. doi:10.1097/BPB.0b013e32832f067a   Perry DC, Achten J, Knight R, et al. Immobilisation of torus fractures of the wrist in children (FORCE): a randomised controlled equivalence trial in the UK. Lancet. Jul 2 2022;400(10345):39-47. doi:10.1016/s0140-6736(22)01015-7   Summarized by Mark O'Brien, MS4 | Edited by John Spartz, MD, & Erik Verzemnieks, MD   In an effort to promote diversity, equity, and inclusion in Emergency Medicine, The Emergency Medical Minute is proud to present our 2nd annual Diversity and Inclusion Award. We support increasing the representation of underrepresented groups in medicine and extend this award to individuals applying to emergency medicine residencies during the 2022-2023 cycle. For information on award eligibility and the application process, visit https://emergencymedicalminute.com/edi-award/ Donate to EMM today!

Welcome to Episode 4 of the BSCOS Paediatric Orthopaedic Digest (POD)cast with guest Ms Claire Murnaghan (@cfmurn) from Royal Children's Hospital Glasgow. We scoured 35 journals & highlighted the most impactful studies that we feel can change practice or improve outcomes in Paediatric Orthopaedics. Follow Updates on @BSCOS_UK REFERENCES: 1. Cast revision is effective for critical three-point index values in paediatric forearm fractures: a prospective study. Subasi et al. J Pediatr Orthop B. Sept 2022. PMID 35132001 2. Concordance of SARS-CoV-2 Results in Self-collected Nasal Swabs vs Swabs Collected by Health Care Workers in Children and Adolescents. Waggoner et al. JAMA. PMID 36018570 3. Effectiveness of an intervention for reducing sitting time and improving health in office workers: three arm cluster randomised controlled trial. Edwarson et al. BMJ. Aug 2022. PMID 35977732 4. High recall bias in retrospective assessment of the pediatric International Knee Documentation Committee Questionnaire (Pedi-IKDC) in children with knee pathologies. Macchiarola et al., KSSTA. Oct 2022. PMID 35218375 5. Two-Year Functional Outcomes of Operative vs Nonoperative Treatment of Completely Displaced Midshaft Clavicle Fractures in Adolescents: Results From the Prospective Multicenter FACTS Study Group. Am J Sports Med. Sept 2022. PMID 35984091 6. Efficacy and Safety of "Sleeper Plate" in Temporary Hemiepiphysiodesis and the Observation of "Tethering". Gerges et al. J Pediatr Orthop. Aug 2022. PMID 35605208 7. Walking activity after multilevel orthopedic surgery in children with cerebral palsy. Church et al. Dev Med Child Neurol. Oct 2022. PMID 35338776 8. Closed reduction and percutaneous pinning versus open reduction and internal fixation for Jakob type 3 lateral condyle fractures in children. Liu et al. Int Orthop. Oct 2022. PMID 35723700 9. 8 out of 10 patients do well after surgery for tarsal coalitions: A systematic review on 1284 coalitions. Hollander et al. Foot Ankle Surg. Oct 2022. PMID 35397990 10. Trends in weight loss attempts among children in England. Ahmad et al. Arch Dis Child. July 2022. PMID 35851294 11. Clinically Detected Leg Length Discrepancy in Patients With Idiopathic Clubfoot Deformity: Prevalence and Outcomes. Addar & Bouchard. J Pediatr Orthop. Aug 2022. PMID 35543605 12. Immobilisation of torus fractures of the wrist in children (FORCE): a randomised controlled equivalence trial in the UK. Perry et al. Lancet. July 2022. PMID 35780790 Follow Hosts: @AnishPSangh @AlpsKothari @Pranai_B

This month we've got two New in EM papers, we look at a scaphoid fracture guideline, explore the RCEMLearning Induction Package and tell you about some new articles in New Online. Be sure to check out the papers and links below! (01:25) New in EM – Midline catheters vs. PICC lines Safety and Outcomes of Midline Catheters vs Peripherally Inserted Central Catheters for Patients With Short-term Indications: A Multicenter Study (14:37) Guidelines for EM – RCEM Suspected Scaphoid Fractures Guideline for the Management of Suspected Scaphoid Fractures in the Emergency Department (43:29) New in EM – Immobilisation of torus fractures in children Immobilisation of torus fractures of the wrist in children (FORCE): a randomised controlled equivalence trial in the UK (01:00:14) RCEM Induction Package RCEMLearning Induction Section ED Starter Pack Booklet Sign your department up to the RCEMLearning Induction Package (01:02:51) New Online – new articles on RCEMLearning for your CPD Heat Related Illness - Jonathan Baird The Climate Crisis – How will air pollution affect my patient's health? - Joanna Quinn Endocarditis - Joydeep Grover

Date: July 22nd, 2022 Reference: Perry et al. Immobilisation of torus fractures of the wrist in children (FORCE): a randomised controlled equivalence trial in the UK. The Lancet 2022 Guest Skeptic: Dr. Tessa Davis is a Paediatric Emergency Consultant at the Royal London Hospital, Senior Lecturer at Queen Mary University of London, Co-founder of Don't Forget The […]

In today's episode, Eric discusses his newest article that describes the drawbacks of “cheat meals” while recommending some more advisable alternatives. After that, Greg presents a Research Review about the time course of detraining when you take some time off from the gym. Finally, Eric answers a listener's question about the potential health benefits of sauna bathing, then closes out the show with some bluegrass music recommendations. SUPPORT THE PODCASTReceive our Research Spotlight newsletter, and check out our Facebook group and subreddit.MacroFactorIf you want to learn more about our MacroFactor diet app, check it out  here.To join in on the MacroFactor conversation, check out our Facebook group and subreddit.MASS Research ReviewSubscribe to the MASS Research Review to get concise and applicable breakdowns of the latest strength, physique, and nutrition research – delivered monthly.Bulk SupplementsFinally, next time you stock up on supplements from BulkSupplements.com, be sure to use the promo code “SBSPOD” (all caps) to get 5% off your entire order. TIME STAMPSIntro/Announcements (0:00)Road to the Stage / Road to Athens (1:10)Feats of Strength (9:04)Front squats 260 x 3281kg front squat at 99kg bodyweightSBS Article Discussion: Cheat meals (11:26)The Drawbacks of “Cheat Meals” (and More Advisable Alternatives)Planned hedonic deviation (29:59)Slack with a cost / “calorie reserve” (31:53)Research Review: Time off from training (41:27)Effect of training cessation on muscular performance: A meta-analysisDelayed myonuclear addition, myofiber hypertrophy, and increases in strength with high-frequency low-load blood flow restricted training to volitional failureEffect of Immobilisation on Neuromuscular Function In Vivo in Humans: A Systematic ReviewExercise dosing to retain resistance training adaptations in young and older adultsHow To Return To Strength Training After An Extended BreakQ&A: Is sauna bathing actually beneficial, or does it just feel nice? (1:03:53)Association between sauna bathing and fatal cardiovascular and all-cause mortality eventsClinical Effects of Regular Dry Sauna Bathing: A Systematic ReviewThe Cardiometabolic Health Benefits of Sauna Exposure in Individuals with High-Stress Occupations. A Mechanistic ReviewSauna use as a lifestyle practice to extend healthspanWhat Is the Impact of Energy Expenditure on Energy Intake?To Play Us Out: Bluegrass music recommendations (1:23:36)

Patients may develop stiffness following rotator cuff repair or other shoulder surgery, particularly with longer periods of immobilisation. On the other hand, some patients may fail rehab without sufficient immobilisation. How can you identify which patients are likely to develop stiffness and will benefit from early mobilisation? Find out in this podcast with Jo Gibson (Clinical Physiotherapy Specialist), and discover: Which patients are likely to benefit from rotator cuff or other surgical repair. How to plan post-op surgical rehab. Whether patients should have a period of immobilisation or not. How to predict patients that are likely to develop post-op shoulder stiffness. Metabolic, genetic, age-related and psychosocial factors that influence development of stiffness. Pre-operative and surgical factors that influence development of stiffness. How to reduce the likelihood of stiffness developing. Comparison between early post-op shoulder mobilisation and six weeks in a sling. Patients more likely to fail a RC repair, who may need more of a conservative approach to early mobilisation. How to explain mobilisation vs immobilisation to patients. Short and long term outcomes when patients develop stiffness. Frozen shoulder If and when corticosteroid injections are helpful. The role of P. acnes in development of frozen shoulder. Free video series “Frozen shoulder assessment & treatment” with Jo Gibson Shoulder: Steps to Success online course with Jo Gibson Improve your assessment and treatment of shoulder pain with the Shoulder: Steps to Success online course with Jo Gibson, now available for enrolment at clinicaledge.co/shouldersuccess Links associated with this episode: Accurately assess, diagnose & treat frozen shoulder, with this free videos series from Jo Gibson Improve acute shoulder pain diagnosis with 3 free videos from Jo Gibson Comprehensively assess and treat shoulder pain with the Shoulder: Steps to Success online course with Jo Gibson Improve your confidence and clinical reasoning with a free trial Clinical Edge membership Join Jo Gibson live on Facebook & ask your shoulder related questions every Monday Download and subscribe to the podcast on iTunes Download the podcast now using the best podcast app currently in existence - Overcast Listen to the podcast on Spotify Jo Gibson on Twitter Let David know what you liked about this podcast on Twitter Review the podcast on iTunes Infographics by Clinical Edge

Immobilisation following a humeral fracture or shoulder surgery quickly results in muscle atrophy and decreased shoulder strength and proprioception. How can you limit strength deficits that develop while patients are in a sling? During this period of immobilisation, cross education (CE) can help retain shoulder strength. This improved shoulder strength and proprioception after the immobilisation period concludes may enable a faster return to work, high load activities or sport. What is CE, and how can you use it in your treatment? Find out in this podcast with Jo Gibson (Clinical Physiotherapy Specialist), and discover: What is cross education (CE)? What the latest research reveals about the effectiveness of CE? Which patients benefit most from CE. Common strength and proprioceptive deficits after shoulder stabilisation surgery. How CE improves strength and proprioception. Recommendations for CE exercise intensity and dosage. Whether to use eccentric, concentric or isometric exercises. How to amplify the strength and cortical effects of CE. How to target the rotator cuff with CE. How to incorporate proprioception into CE. How to use CE in rehab for instability, movement apprehension & kinesiophobia. When to include CE in MRCT post-op rehab. Get free access to the free video series “Frozen shoulder assessment & treatment” with Jo Gibson at clinicaledge.co/shoulder Improve your assessment and treatment of shoulder pain with the Shoulder: Steps to Success online course with Jo Gibson, now available for enrolment at clinicaledge.co/shouldersuccess Free video series “Frozen shoulder assessment & treatment” with Jo Gibson Shoulder: Steps to Success online course with Jo Gibson Improve your assessment and treatment of shoulder pain with the Shoulder: Steps to Success online course with Jo Gibson, now available for enrolment at clinicaledge.co/shouldersuccess Links associated with this episode: Get your access to the free video series “Frozen shoulder assessment & treatment” with Jo Gibson Improve your shoulder assessment & treatment with the Shoulder: Steps to Success online course with Jo Gibson Improve your confidence and clinical reasoning with a free trial Clinical Edge membership Join Jo Gibson live on Facebook & ask your shoulder related questions every Monday Download and subscribe to the podcast on iTunes Download the podcast now using the best podcast app currently in existence - Overcast Listen to the podcast on Spotify Jo Gibson on Twitter Let David know what you liked about this podcast on Twitter Review the podcast on iTunes Infographics by Clinical Edge

durée : 00:31:45 - Le dossier du jour FB Touraine - Voilà des semaines que vous êtes en télétravail ou que vous ne vous servez plus de votre voitures pour telle ou telle raison ! Alors que faire pour bien préparer sa voiture après de longues semaines d’immobilisation? Revue de détails dans le Dossier du Jour

Welcome back to the VTE Dublin Podcast where you’ll find all the recent talks from the VTE Dublin Conference. Be sure to subscribe to the VTE Dublin Podcast Thromboprophylaxis for lower limb immobilisation after injury (TiLLI): Systematic review and economic evaluation Prof. Dan Horner | Professor of the Royal College of Emergency Medicine | Consultant […]

According to medical and mental health experts, people really do have the ability to change. Three types of changes:A change of process -e.g. 2 stage authentications on phone apps, covid-19 restrictionsA change of mind – e.g. different location, different relationship, different careerA change of circumstances – e.g. home ownership, adopt a puppy, promotion to leader, reduced salary, reduced headcount, isolation from peers, marriage, loss of family member. A popular framework used by psychologists to explain how humans experience change is the Kubler-Ross 5 stages of grief. E.g. Facebook announces they are going to make location marking on images mandatory...we could experience the following:Stage 1: Denial. “They won’t do that, it’s fake news.”Stage 2: Anger. “How dare they, that’s an invasion of privacy.”Stage 3: Bargaining. “Check the fine print for opt out/out in options.”Stage 4. Depression. “I’m over Facebook, I hate it.”Stage 5. Acceptance. “I’ve opted out so I’m OK with it all really.”The feelings experienced in each of the Kubler-Ross stages may be fleeting or drawn out…there is no hard and fast rule here – just an acknowledgment that they do exist. The Kubler-Ross model has traditionally been associated with unplanned changes.Ralph Lewis and Chris Parker, in their article ‘Beyond the Peter Principle – managing successful transitions’ describe a 7-stage evolutionary process that can help explain what happens to us during planned or unplanned changes, negative or positive changes.Using the example of the feelings experienced when a person gets promoted into a leadership role above their peers, Lewis and Parkers’ research concluded the following 7 stages:Immobilisation – pleased yet shocked that they got the job. A sense of overwhelm.Denial of change – minimising or trivialising the size of the change or the effort put in to obtain the changeIncompetence – flat performance, frustration, difficulty in copingAcceptance of reality – letting go of the past (skills) and accepting the situationTesting – trying new approaches, mostly new ways of communicating, reshaping self-imageSearch from meaning, internalisation – a reflective period with an attempt to understand all that has happened. Accepting your new self-imageIntegration – incorporating new meanings into new and enhance behaviours. Consolidating your new self-image.Individuals can move more easily through a change if they are:Self-aware – which phase of the change process am I inAccepting of the change and the change process.Employing a coach is beneficial as they can help you reflect, acknowledge, accept, innovate, practise and mould successful behaviours and ways of thinking. What happens if I find myself in an untenable situation…how do I make the change?Four options model (with examples of someone who isn’t satisfied with the role they find themselves in following after an organisational restructure).Leave the organisation.Change the situation. Take on extra responsibilities (of interest to you).Put up with the situation. Stay in the job and continue to feel dissatisfied.Change yourself or how you feel about the temporary situation. Acknowledge this is a temporary role and you will do as good a job as you can whilst looking for the next step in your career -this may help dispel feelings of dissatisfaction.NB. Changing yourself is different from merely putting up with the situation since your thoughts, feelings and behaviour are different in the two cases.  References:Bridges, W. (1991). Managing transitions: making the most of change. Reading, Mass, Addison-WesleyHyde, Peter. (2014). Personal transitions. Available: http://peterhyde.co.uk/wpcontent/uploads/2013/09/Personal-transitions.pdf. Last accessed February 2016.Kubler-Ross, E. (1969). On death and dying. New York: Macmillan.Parker, Chris Lewis, Ralph. (1981). Beyond the Peter Principle, Managing Successful Transitions. Available: http://www.ralphlewis.co.uk/Change_files/Beyond%20the%20Peter%20Principle.pdf. Last accessed August 2020.

Selten wurde so etwas so kontrovers in letzter Zeit bei uns diskutiert wie die HWS-Immobilisation und unser „Tod“ der HWS-Orthese. Wir erklären uns nochmal! Den Original-Beitrag findet ihr hier Der Beitrag „titriert“ Kochrezept – HWS-Immobilisation erschien zuerst auf pin-up-docs - don't panic.

Survenue le 3 janvier 2020, la mort de Cédric Chouviat met une nouvelle fois en lumière la dangerosité de certains « gestes techniques » et techniques d’immobilisation : clefs d’étranglement, plaquages ventraux, pliages, utilisés par les policiers. Ce vendredi, des collectifs de victimes de violences policières et leurs soutiens lancent un appel inédit à travers une tribune. Ils dénoncent l’impunité des brutalités policières et invitent à une marche, à Paris, le 14 mars. Faites un don à https://radioparleur.net/don/

Unsere dritte Folge mit Themen zu Immobilisation im Rettungsdienst, Katecholamine, Dialyse auf der ITS, der Antiinfektiven Therapie des Monats, Journal Club und vielem mehr. Details in den Shownotes. News und Ergänzungen https://nerdfallmedizin.blog/tag/gerinnung/ Yadav, Krishan, et al. „Predictors of Oral Antibiotic Treatment Failure for Nonpurulent Skin and Soft Tissue Infections in the Emergency Department.“ Academic Emergency Medicine (2019). Iversen, Kasper, et […] Der Beitrag Podcast März – Folge 3 erschien zuerst auf pin-up-docs - don't panic.

This is the second part of the podcast talking to Dr Patrick J Kenny. Pat was a senior lecturer here at the RVC lecturer in veterinary neurology and neurosurgery, though has recently returned home to Sydney. We talk to Pat about an approach to spinal trauma, the Do’s and Don’ts, what imaging to perform and how to immobilise a patient. We pick up shortly after we were side tracked talking about steroids.   Immobilisation Primary survey (ABC’s, or major body systems) Oxygen Check for deep pain Analgesia Secondary survey Focus on maintaining blood pressure and keep up with oxygenation Diagnostic imaging – survey radiographs and CT        If you have any comments about this podcast, please get in touch (email dbarfield@rvc.ac.uk; tweet @dombarfield or @RoyalVetCollege using #rvcpod; or use the RVC facebook page). We would greatly appreciate your time to rate us on iTunes and write a review.

This is the second part of the podcast talking to Dr Patrick J Kenny. Pat was a senior lecturer here at the RVC lecturer in veterinary neurology and neurosurgery, though has recently returned home to Sydney. We talk to Pat about an approach to spinal trauma, the Do’s and Don’ts, what imaging to perform and how to immobilise a patient. We pick up shortly after we were side tracked talking about steroids. Immobilisation Primary survey (ABC’s, or major body systems) Oxygen Check for deep pain Analgesia Secondary survey Focus on maintaining blood pressure and keep up with oxygenation Diagnostic imaging – survey radiographs and CT If you have any comments about this podcast, please get in touch (email dbarfield@rvc.ac.uk; tweet @dombarfield or @RoyalVetCollege using #rvcpod; or use the RVC facebook page). We would greatly appreciate your time to rate us on iTunes and write a review.

In this podcast, we talk to Dr Patrick J Kenny. Pat was a senior lecturer here at the RVC lecturer in veterinary neurology and neurosurgery, though has recently returned home to Sydney. We talk to Pat about an approach to spinal trauma, the Do’s and Don’ts, what imaging to perform and how to immobilise a patient.   Immobilisation Primary survey (ABC’s, or major body systems) Oxygen Check for deep pain Analgesia Secondary survey Focus on maintaining blood pressure and keep up with oxygenation Diagnostic imaging – survey radiographs and CT       If you have any comments about this podcast, please get in touch (email dbarfield@rvc.ac.uk; tweet @dombarfield or @RoyalVetCollege using #rvcpod; or use the RVC facebook page). We would greatly appreciate your time to rate us on iTunes and write a review.

In this podcast, we talk to Dr Patrick J Kenny. Pat was a senior lecturer here at the RVC lecturer in veterinary neurology and neurosurgery, though has recently returned home to Sydney. We talk to Pat about an approach to spinal trauma, the Do’s and Don’ts, what imaging to perform and how to immobilise a patient. Immobilisation Primary survey (ABC’s, or major body systems) Oxygen Check for deep pain Analgesia Secondary survey Focus on maintaining blood pressure and keep up with oxygenation Diagnostic imaging – survey radiographs and CT If you have any comments about this podcast, please get in touch (email dbarfield@rvc.ac.uk; tweet @dombarfield or @RoyalVetCollege using #rvcpod; or use the RVC facebook page). We would greatly appreciate your time to rate us on iTunes and write a review.

C-spine immobilisation is a controversial topic because of a lack of high quality evidence from clinical trials. Historical approaches have been challenged, however NICE guidance continues to recommend 3-point immobilisation for all patients with suspected spinal injury despite considerable clinical equipoise. In this episode we discuss the complexities of balancing the risks and harms when trying to provide a patient centred approach, rather than a “one-size fits all” model.   As always, there are a number of papers, guidelines and resources that you should have a look at (it’s not exhaustive, but a good place to start!)   Enjoy!   Rob References & Further Reading     NICE Guidance   Major trauma   Spinal injury    Faculty of prehospital care consensus statements   Spinal immobilisation   Minimal patient handling   Cochrane reviews   Spinal Immobilisation for Trauma   Papers of interest   Cowley et al 2017   Dixon et al 2015   Benger & Blackham 2009   Hauswald 2015   Hauswald 2013   Michaleff et al 2012   Podcasts   RCEM Learning   EMCrit

Health Minutes with Dr Holgate. ER24's health talk show on health awareness. Dr Holgate provides us with some insight into the difficult questions often asked in home-based medical care and emergency medicine.

Prevention of venous thrombosis after knee-replacement surgery (ADVANCE-2 study).

Die Behandlung der atrophen Pseudarthrose stellt in der Orthopädie und Unfallchirurgie eine große Herausforderung dar. Die Pseudarthrose sowie deren gegenwärtig angewandte Therapiestrategien haben weitreichende interdisziplinäre Auswirkungen. In diesem Zusammenhang seien lange Immobilisation, Krankenhausaufenthalte und hohe Kosten für das Gesundheitswesen genannt. Deshalb ist es dringend geboten effiziente Behandlungskonzepte zu finden. Die extrakorporale Stosswellentherapie (ESWT) könnte als Therapiealternative geeignet sein, wobei jedoch trotz intensiver orthopädisch-interdisziplinärer Forschung bisher wenig über deren Wirkmechanismen bekannt ist. Hinzu kommt, dass die Inhomogenität der bisher durchgeführten Untersuchungen zur ESWT die fachgerechte Wertigkeitseinschätzung dieser Behandlungsmethode erschwert. In der vorliegenden Studie wurde die Wirkweise extrakorporaler Stosswellen am pathologisch veränderten Knochen, speziell am etablierten Kaninchenmodell nach In-duktion einer atrophen Pseudarthrose, geprüft. Zu diesem Zweck wurden 14 New Zealand White Rabbits (Behandlungsgruppe n = 6, Kontrollgruppe n = 8) an der Tibia mit einem Fixateur externe versehen sowie osteotomiert und devastiert. Acht Wochen postoperativ wurden die Tiere der Behandlungsgruppe mit fokussierter ESWT behandelt. Die Energieflussdichte betrug 0,5 mJ/mm² bei 1500 Impulsen (zweimal 750 Impulse, die jeweils distal und proximal zum Knochenspalt fokussiert wurden) und einer Frequenz von 1 Hz. Die Kaninchen der Kontrollgruppe wurden einer Scheinbehandlung unterzogen. Die Ergebnisse resultierten aus klinischen und radiologischen Betrachtungen sowie histomorphologischen und histomorphometrischen Analysen. Die histopathologischen Untersuchungen unterteilten sich in mikroradiografische Bilder der Knochenpräparate und in paragongefärbte Dünnschnittpräparate. Die Resultate zeigten in den Variablen „Klinische Evaluation“, „Bindegewebsbildung“, „Reaktionstyp der Kallusbildung“, „Mittleres relatives Ausmaß der Kallusbildung – periostal“, „Bruchspalt-durchbauung“ und „Quantitative Erfassung der Knochenneubildung“ signifikante bis zum Teil hochsignifikante Unterschiede zwischen den behandelten und unbehandelten Tiergruppen. Zusammenfassend ergibt sich, dass beim pathologisch veränderten Knochen eine beschleunigte knöcherne Ausheilung durch extrakorporale Stosswellen zu erzielen ist.

Fri, 9 Feb 2007 12:00:00 +0100 https://edoc.ub.uni-muenchen.de/6751/ https://edoc.ub.uni-muenchen.de/6751/1/Busch_Franziska.pdf Busch, Franziska

Fri, 9 Feb 2007 12:00:00 +0100 https://edoc.ub.uni-muenchen.de/6620/ https://edoc.ub.uni-muenchen.de/6620/1/Lenz_Andrea.pdf Lenz, Andrea

Fortschreitender Knochenmasseverlust und sekundäre Osteoporose sind häufige Komplikationen bei Patienten mit chronischer Herzinsuffizienz. Aufgrund von Schmerzen, spontanen Frakturen und eventuell dauerhafter Immobilisation werden die ohnehin schon schwer erkrankten Patienten noch weiter beeinträchtigt. Bisher jedoch gibt es noch keine Standardtherapie für die sekundäre Osteoporose nach Herzinsuffizienz. In vorliegender Arbeit wurde deshalb erstmals der Effekt einer Osteoporose-Therapie mit Alfacalcidol (1-α-Hydroxy-Vitamin D3) plus Calcium auf den Knochenstoffwechsel von Patienten mit chronischer Herzinsuffizienz untersucht. Dies geschah in interdisziplinärer Zusammenarbeit mit der Medizinischen Poliklinik Innenstadt der Ludwig-Maximilians-Universität München. Es sollte evaluiert werden, ob diese Therapie entscheidende Vorteile gegenüber der alleinigen prophylaktischen Gabe von Calcium bietet. Patienten mit chronischer Herzinsuffizienz erhielten im ersten Studienjahr eine Basisgabe von 500 mg Calcium und im 2. Studienjahr eine Kombinationstherapie aus 1 µg Alfacalcidol plus 500 mg Calci-um. Als Hauptzielgrößen für den Therapieerfolg dienten die biochemischen Parameter des Knochenstoffwechsels und die Entwicklung der Knochendichte. Als Marker der Knochenformation wurden das nichtkollagene Knochenprotein Osteocalcin und die Knochenspezifische Alkalische Phosphatase, als Marker der Knochenresorption die Pyridinium-Crosslinks Pyridinolin und Desoxypyridinolin herangezogen. Die Messung der Knochendichte erfolgte mittels Zweispektren-Röntgenabsorptiometrie (DXA) an Lendenwirbelsäule (LWS) und Femur. Zu Studienbeginn zeigten die Patienten einen gestörten Knochenstoffwechsel mit physiologischer Knochenformation und erhöhter Knochenresorption. Die mittlere Knochendichte an Femur und Len-denwirbelsäule war gemäß der WHO-Definition im Sinne einer Osteopenie vermindert. Eine Osteopo-rose war bei 18 % der Studienteilnehmer am Femur und bei 23 % an der LWS nachweisbar. 41 % der Patienten litten zudem an einem sekundären Hyperparathyreoidismus, welcher einen wichtigen Faktor bei der Krankheitsentstehung darstellt. Die Untersuchung ergab, dass unter dem Einfluss der alleinigen Calciumgabe im ersten Studienjahr die Knochenresorption weiter anstieg und auch der fortschreitende Verlust an Knochenmasse nicht aufgehalten werden konnte. Hingegen bewirkte die Therapie mit Alfacalcidol plus Calcium im zweiten Studienjahr eine Normalisierung des Knochenstoffwechsels. Die Knochendichte an der Lendenwirbelsäule und am Femurhals stieg unter der Therapie mit Alfacalcidol plus Calcium hochsignifikant an. In vorliegender Arbeit konnte gezeigt werden, dass die alleinige Gabe von Calcium nicht geeignet ist, den pathologischen Knochenstoffwechselvorgängen bei Patienten mit chronischer Herzinsuffizienz entgegen zu wirken. Hingegen stellt die Kombination aus Alfacalcidol plus Calcium eine geeignete Therapie dar, durch welche die erhöhte Knochenresorption gehemmt, der fortschreitende Knochenverlust aufgehalten und in Folge eine Steigerung der Knochenmasse herbeigeführt wird.

The objective of the present study was to examine the effectiveness of the anesthetic combination "Hellabrunne mixture" ("HM" = approximately 125mg xylazine/ml and 100mg ketamine/ml) on hamadryas baboons, as well as the influence of various drugs over the time it took the baboons to wake up (their "waking up phase") under practical conditions. In order to remobilize the baboons, comparative studies were conducted using: alpha2-specific antagonists atipamezole and yohimbine as well as the circulation stimulating drug etilefrine. The "HM" proved to be a very safe and effective anesthetic, even when given in doses that were too low or when overdosed. None of the examined animals had any life threatening incidents. All of the measured physiological parameters were normal and remained stabile during anesthesia. The three assayed accelerators used to remobilize the baboons (atipamezole, yohimbine, etilefrine) showed substantial differences in their effects. Atipamezole caused the baboons to regain consciousness significantly faster than the other drugs. However, some of the animals that were administered atipamezole had catalepsis cramps during their waking up phase. These side effects can be explained most likely, by the fact that atipamezole only antagonizes the xylazine component of the "HM" which causes a relative overdose of ketamine. Examining the effects of yohimbine administered i.m. (in contrast to the usual i.v. administration) yielded no substantial acceleration of remobilization. The same side effects were observed after administering atipamezole. Similar to atipamezole, etilefrine also shortened the waking up phase significantly, but to a lesser extent than atipamezole. In contrast to atipamezole and yohimbine, no side effects were observed after administering etilefrine. In summary, the i.m. administration of atipamezole and etilefrine proved to be suitable to shorten the waking up phase of hamadryas baboons after using "HM". In contrast, yohimbine cannot be recommended, as noticeable side effects were evident and no significant acceleration of remobilization was observed.

Tue, 1 Jan 1991 12:00:00 +0100 http://epub.ub.uni-muenchen.de/8338/ http://epub.ub.uni-muenchen.de/8338/1/8338.pdf Wiesner, Henning; Gruber, A.; Hegel, G. von Ippen, Rudolf (Hrsg.) (1991): Neue Möglichkeiten der Immobilisation vom Strauß (Struthio camelus). 33. Internationales Symposium über die Erkrankungen der Zoo- und Wildtiere, 08.05.-12.05.1991, Liberec. Tiermedizi

Mon, 1 Jan 1990 12:00:00 +0100 http://epub.ub.uni-muenchen.de/8261/ http://epub.ub.uni-muenchen.de/8261/1/8261.pdf Wiesner, Henning; von Hegel, Gisela Wiesner, Henning und von Hegel, Gisela (1990): Zur Immobilisation von Wildequiden mit STH 2130 und Tiletamin/Zolazepam. In: Tierärztliche Praxis, Vol. 18, Nr. 2: pp. 151-154. Tiermedi

Sun, 1 Jan 1989 12:00:00 +0100 http://epub.ub.uni-muenchen.de/8257/ http://epub.ub.uni-muenchen.de/8257/1/8257.pdf Wiesner, Henning; Hegel, G. von Wiesner, Henning und Hegel, G. von (1989): Zur Immobilisation von Giraffen. In: Tierärztliche Praxis, Vol. 17, Nr. 1: pp. 97-100. Tiermedizin

Tue, 1 Jan 1985 12:00:00 +0100 http://epub.ub.uni-muenchen.de/8218/ http://epub.ub.uni-muenchen.de/8218/1/8218.pdf Wiesner, Henning; Hegel, G. von Wiesner, Henning und Hegel, G. von (1985): Praktische Hinweise zu Immobilisation von Wild- und Zootieren. In: Tierärztliche Praxis, Vol. 13: pp. 113-127. Tiermedizin

Mon, 1 Jan 1979 12:00:00 +0100 http://epub.ub.uni-muenchen.de/8099/ http://epub.ub.uni-muenchen.de/8099/1/8099.pdf Trillmich, F.; Wiesner, Henning Trillmich, F. und Wiesner, Henning (1979): Immobilisation of free-ranging Galapagos sea lions. In: The Veterinary Record, Vol. 105, Nr. 20: pp. 465-466. Tiermedizin