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Managing Crush Injuries on Arrival
Published in Kajal Jain, Nidhi Bhatia, Acute Trauma Care in Developing Countries, 2023
Sarvdeep Singh Dhatt, Deepak Neradi
Hyperbaric oxygen therapy increases soluble oxygen in the blood and improves outcomes. Hyperoxia achieves this in crush injury patients by increasing oxygen supply to underperfused tissue, decreasing interstitial oedema (vasoconstriction due to hypoxia), inhibiting free radical formation, facilitating phagocytosis and enhancing wound healing. After fasciotomy, topical negative pressure (TNP) dressings help improve wound healing and minimize infection by reducing oedema, inhibiting local infection and increasing granulation. Management of crush injuries is depicted in a flow chart in Figure 27.4.
Diagnosis and Treatment of Inhalation Injury in Burn Patients
Published in Jacob Loke, Pathophysiology and Treatment of Inhalation Injuries, 2020
Khan Z. Shirani, Joseph A. Moylan, Basil A. Pruitt
To accelerate carbon monoxide elimination and to reverse tissue hypoxia, hyperbaric oxygen has been used with success in patients with carbon monoxide poisoning (Smith and Brandon, 1970). In six unconscious carbon monoxideintoxicated patients who were indifferent to previous treatment with normobaric 100% oxygen, the use of pure oxygen at 2.8-3 ATA was considered to have improved their neurologic recovery. Hyperbaric oxygen therapy in those individuals was given over a 46-161 min period. In all but one of those patients, hyperbaric oxygen therapy was repeated once in the ensuing 6-8 hr. All patients survived and five made apparently full neurologic recovery (Myers et al., 1981).
Sub-atmospheric decompression illness
Published in Nicholas Green, Steven Gaydos, Hutchison Ewan, Edward Nicol, Handbook of Aviation and Space Medicine, 2019
Nicholas Green, Steven Gaydos, Hutchison Ewan, Edward Nicol
Hyperbaric oxygen therapy: Symptoms may resolve on descent or following administration of 100% oxygen at ground level.Threshold to treat by recompression is now generally low, even if symptoms have resolved.Hyperbaric oxygen therapy according to US Navy Table 6 or equivalent in hyperbaric chamber.Table may be repeated or extended as required.Intermittent oxygen therapy (risk of oxygen toxicity).Manage circulatory collapse with intravenous fluids; consider high-dose corticosteroids.
Reduction mammoplasty and mastopexy in the previously irradiated breast – a systematic review and meta-analysis
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Anne Kathrine Lorentzen, Jørgen Lock-Andersen, Louise Wichmann Matthiessen, Tobias Wirenfeldt Klausen, Lisbet Rosenkrantz Hölmich
Attempts at reducing postoperative complications by using prophylactic measures have been described. Snyder et al. [50] reported data on five patients treated with reduction mammoplasty on previously irradiated breasts, combined with adjuvant hyperbaric oxygen therapy pre- and postoperatively. Delayed wound healing was reported in two irradiated and two non-irradiated breasts, but no further complications were seen. Hyperbaric oxygen therapy increases angiogenesis and vascularization and may prove beneficial in reducing postoperative complications. However, the feasibility of this protocol limits its clinical use, and evidence for this preventive measure is lacking. In another case report, Sterodimas et al. [51] used buflomedil (a vasoactive agent that increases microcirculation) in a patient undergoing bilateral breast reduction after unilateral lumpectomy and irradiation. Buflomedil was administered intravenously for 2 days, followed by a 14-day oral course. No complications were seen. With only one study investigating the benefit of buflomedil in reducing postoperative complications, further studies are needed.
The discovery and development of inhaled therapeutics for migraine
Published in Expert Opinion on Drug Discovery, 2019
Nicolas Vandenbussche, Peter J Goadsby
Few trials have documented the use of oxygen for the acute treatment of migraine attacks. Myers and colleagues were the first to publish a small study in 1995 providing data that hyperbaric oxygen may be effective for the alleviation of migraine compared to normobaric treatment [53]. A Cochrane review analyzed five separate trials applying hyperbaric oxygen therapy for acute migraine treatment [54]. The authors concluded that hyperbaric oxygen therapy was effective in relieving migraine headaches compared to sham therapy (risk ratio (RR) 6.21, 95% CI 2.41–16.00; 58 participants, three trials). No trial could prove migraine prevention, reduced incidence of nausea and vomiting or reduction in the requirement of rescue medication. All included trials had methodological issues and low patient numbers. Except for claustrophobia in a few patients, no AEs of the therapy were noted. Hyperbaric oxygen therapy is a difficult therapy for routine clinical practice in terms of logistics and costs.
Intratympanic methylprednisolone administration promotes the recovery of idiopathic sudden sensorineural hearing loss: a retrospective case-control study
Published in Acta Oto-Laryngologica, 2018
Kanglun Jiang, Shuna Li, Lan Cheng, Jun Yang
Three hundred and twenty-eight ISSNHL patients were diagnosed. Of these, 15 patients were excluded due to incomplete demographic data, whereas only 313 individuals with age ranging from 13 to 84 years were enrolled in this study. Three hundred and thirteen patients including 159 males and 154 females with ISSNHL were enrolled in our study. The age of the participants ranged from 13 to 84 and the mean age was 52 ± 13 years. The mean duration from onset to treatment (the number of days from the onset of hearing loss to the initiation of treatment) was 6 ± 7 d. Eighty-one individuals accepted intratympanic injection with DXM, while 46 individuals accepted intravenous injection with DXM and 88 participants accepted combination treatment (extra DXM intratympanic injection based on intravenous DXM). Besides, 98 patients accepted treatment of intratympanic injection with methylprednisolone. All individuals were treated by hyperbaric oxygen therapy as an assistance treatment. The remaining detailed clinical and demographic data were shown in Table 1.