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The Paediatric Consultation
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Tachycardia and prolonged capillary refill time are early signs of circulatory compromise. Capillary refill is best assessed centrally: digital pressure is applied on the sternum for 5 sec to blanch the skin and then the pressure is released, and colour should return to normal within 2 sec. Pulse rate is best assessed by manual palpation of the central vessels, such as the carotid or femoral arteries, in conjunction with pulse oximetry, accepting the limitations outlined above. Bradycardia and hypotension are late signs and may signify an impending cardiac arrest.
Hematomas
Published in Nilton Di Chiacchio, Antonella Tosti, Therapies for Nail Disorders, 2020
A complete dermatological examination is necessary in evaluating nail hematomas. The physical examination requires removal of nail cosmetics and artificial nails followed by an examination of the skin, hair, mucosa, and all 20 nails. Violaceous patches on the skin may indicate senile purpura, a bleeding disorder, or medication use such as prednisone or warfarin. The nails should be examined on a flat surface with the fingers and toes spread apart. A complete examination requires an evaluation of the patient while standing, as well as the gait to check for toe overlap, pressure on particular toes, or favoring one side of the body with weight. The nails, nail folds, and hyponychium are examined, as well as the degree of onycholysis when present. The digit is also examined for motor function, sensation, and circulation. Pressure is applied to the dorsal digit and strength of extension is evaluated. Capillary refill is employed to test circulation.
Paediatrics
Published in Elizabeth Combeer, The Final FRCA Short Answer Questions, 2019
C: Intravenous access, ideally two cannulae. Obtain intraosseous access if intravenous access not immediately feasible. Assess for signs of shock: Capillary refill time greater than 2 seconds.Unusual skin colour.Tachycardia and/or hypotension.Cold hands/feet.Toxic/moribund state.Altered mental state/decreased conscious level.Poor urine output.
Degree of Soft Tissue Injury is a Major Determinant of Successful Arterial Repair in the Extremity: A New Classification of Extremity Arterial Injury?
Published in Journal of Investigative Surgery, 2022
Peijun Deng, Jiantao Yang, Jacques Henri Hacquebord, Bengang Qin, Honggang Wang, Ping Li, Liqiang Gu, Jian Qi, Qingtang Zhu
Following institutional review board approval (NO. 2021247), a retrospective study was conducted on data from all adult patients treated in our institution for traumatic extremity arterial injury of a major vessel between January 2013 and December 2020. The inclusion criteria were as follows: 1) single or multiple arterial injury in an extremity and resulting in 2) ipsilateral limb ischemia at the time of presentation. Limb ischemia was defined as 1) poor capillary refill or 2) weak pulse or pulselessness. The exclusion criteria were:1) age < 16 years, 2) injury below the wrist and ankle, 3) unstable vital signs, 4) polytrauma, 5) preexisting peripheral vascular disease, and 6) traumatic amputation. Finally, 106 patients were included in this study (Figure 1). The median age of patients was 36 years [interquartile range (IQR): 25.25-45], with 16 women and 90 men.
Spontaneous radial artery pseudoaneurysm in an infant due to idiopathic medial hypoplasia – a case report
Published in Case Reports in Plastic Surgery and Hand Surgery, 2019
William W. Kesler, Joseph J. Maleszewski, Alexander H. Payatakes
Intraoperatively, the arterial lesion was noted to be multi-lobular, focally bluish, and adhered to the flexor carpi radialis sheath, with the volar carpal branch of the radial artery exiting the mass. (Figure 3(A)). The radial artery was dissected to healthy vessel wall (proximally to the mid-forearm and distally past the wrist flexion crease). Trial clamping of the radial artery proximally and distally demonstrated maintenance of brisk distal capillary refill throughout, confirming a complete, patent arch. The radial artery was transected and the abnormal segment excised. Robust arterial backflow was noted from the distal stump of the radial artery following transection. Reconstruction with vein graft was not felt to be necessary and would additionally result in significantly prolonged anaesthesia time for such a young patient. The radial artery was therefore simply ligated.
An infant presenting with failure to thrive and hyperkalaemia owing to transient pseudohypoaldosteronism: case report
Published in Paediatrics and International Child Health, 2018
Marieke De Clerck, Johan Vande Walle, Evelyn Dhont, Joke Dehoorne, Werner Keenswijk
On examination, he was alert and not distressed, his temperature was 37.5 °C, heart rate 156 beats/minute, respiratory rate 45/minute, blood pressure 104/66 mm Hg and oxygen saturation 100%. Weight was 5110 g (10th centile) (270 g less than a month earlier), length 61 cm (37th centile) and head circumference 40.5 cm (25th centile). Nutritional status was suboptimal with reduced subcutaneous fat. There were signs of mild dehydration with dry mucosal membranes (lips, tongue) but capillary refill time was <2 s and skin turgor was normal. There was no skin hyperpigmentation or indrawing of the chest and his genitalia were normal. Results of the remainder of the examination were unremarkable.