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Advanced Rhinoplasty
Published in Suleyman Tas, Rhinoplasty in Practice, 2022
In thick-skinned patients, wing excision is often required to readjust the skin envelope, which often results in scarring. However, if suturing is done on the alar sulcus with subcutaneous sutures, skin sutures are properly removed, the area is protected with sunscreen for at least one year and silicone gel treatment is used for three months, scarring will be minimal (Figure 7.30). It is best to inform the patient that hypertrophic and keloid scarring usually do not occur in the mid-face, but protective measures should still be followed (Figure 7.31).
The Entomological Aspects of Onchocerciasis Control in the Volta River Basin
Published in Max J. Miller, E. J. Love, Parasitic Diseases: Treatment and Control, 2020
Larvicides are applied almost exclusively by air. This is the only feasible method, due to the lack of ground accessibility in many river valleys, and especially to the length of watercourses potentially suitable for vector breeding which have to be surveyed every week (23,000 km in the wet season, reduced to 8000 to 1300 km in the dry season). Because of their good maneuverability at low air-speeds, helicopters are used to treat small rivers or large rapid complexes containing many small channels. They are also used to apply formulations, such as B.t. H14, requiring relatively slow releases. The use of fixed-wing aircraft is restricted to large watercourses where high volumetric dosages are required.
Homeopathy: principles, practice and controversies
Published in Geraldine Lee-Treweek, Tom Heller, Hilary MacQueen, Julie Stone, Sue Spurr, Complementary and Alternative Medicine: Structures and Safeguards, 2020
Phil Nicholls, Geraldine Lee-Treweek, Tom Heller
Someone with this symptom picture would be treated with the remedy (using the rule that ‘like cures like’). Note that this remedy is not for a disease or a specific illness: it is solely for treating a range of diverse symptoms. In this case, the remedy is heavily related to feelings, emotions, doubts and personality and is another example of how the homeopathic practitioner is involved with painstakingly collecting information from the person and then matching symptoms to seek the correct homeopathic remedy. Some homeopathic practitioners argue against the use of bird remedies, claiming that it is not homeopathy. They suggest that the development of a new homeopathic remedy must involve the procedure Samuel Hahnemann used more than 200 years ago: that is, see whether an undiluted substance causes the same symptoms in many people with good health. For example, to evaluate the symptoms caused by a mosquito, use the poison of the insect not the wings to claim the remedy could be effective against insect bites rather than a fear of flying.
Pericardiocentesis by an Air Medical Service for Cardiac Tamponade Caused by Purulent Pericarditis
Published in Prehospital Emergency Care, 2023
Timothy Boardman, Nicholas North, Sara Sullivan
Procedures during air medical transport, whether rotor wing or fixed wing, present certain challenges. Air medical clinicians preferentially perform immediate and lifesaving interventions to stabilize the patient prior to transport whether this be at the sending facility or in the back of an ambulance. Air medical transport is a dynamic environment with many factors that can affect transport. Space constraints can limit the ability of air medical clinicians to perform certain procedures effectively in-flight. Weather conditions, such as strong winds, may prevent clinicians from coming out of their seatbelts when certain positioning is needed to complete procedures. Long transport times are another variable. With fixed wing transports, transport times may be hours long. If the patient decompensates, there is little chance of landing immediately to divert to an alternate destination. Stabilization of the patient prior to transport is key for air medical transport regardless of modality. In this discussed case, the pericardiocentesis was performed prior to transport and the patient required additional aspiration of fluid in flight to maintain hemodynamics. Whether the mode of transport is fixed wing or rotor wing, the approach to the pericardiocentesis procedure is the same.
Pinch points in the consultation – and how to avoid them
Published in Education for Primary Care, 2023
Patients frequently give cues as to which wing(s) they want to visit. Cues such as ‘I was just a bit worried’; ‘I don’t want to waste your time’ or ‘I know I shouldn’t but I looked up on Google’ all suggest a wish for increased understanding, while cues including ‘this can’t go on’; ‘it’s stopping me being able to work’ and ‘I just need a good night’s sleep’ all suggest a wish to find a solution. Being alert to these cues, checking what the patient is looking for with phrases like ‘did you want to talk about stronger pain killers?’ and even overtly asking ‘so did you just want to have a better understanding of what is going on here, or were you looking for a solution?’ can all help the doctor avoid this pinch point altogether and make sure they travel with the patient to the right destination in the decision-making process (Figure 2).
Air Versus Ground Transport Times in an Urban Center
Published in Prehospital Emergency Care, 2023
Jeremy B. Richards, Michael A. Frakes, Christian Grant, Jason E. Cohen, Susan Renee Wilcox
The time to arrival at the patient was also notably shorter. In many circumstances, bringing a critical care transport team to a relatively resource poor hospital can offer benefit. We have previously demonstrated that our teams improve ventilator settings in patients with severe hypoxemic respiratory failure, by decreasing tidal volumes, increasing PEEP, and administering neuromuscular blockade (15), interventions which are associated with a significant improvement in oxygenation (16). Additionally, critical care transport teams can provide advanced therapies, bringing medications such as inhaled epoprostenol (17) and blood products (18) to hospitals that may be limited in these resources. As such, getting the teams to the bedside of critically ill patients rapidly is another advantage associated with rotor wing transport.