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Analgesia and Anaesthesia
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Extremes of temperature can make pain seem more intense, especially systemic coldness, which can provoke shivering and thus movement of injured body parts. Although use of ‘spinal’ or extrication boards for transport has been discontinued, patients may still end up lying on trolleys for several hours unable to move and this can cause discomfort and agitation. Transfer to a vacuum mattress will considerably ease the patient’s discomfort. Another often-overlooked cause of increasing discomfort in trauma is a full bladder, especially if the patient has received intravenous fluids. If the patient is likely to be immobile for any length of time, consideration should be given to insertion of a urinary catheter. These are simple manoeuvres but together can alleviate a substantial amount of pain and distress, making any pharmacological intervention more effective.
Entrapment and extrication
Published in Ian Greaves, Keith Porter, Chris Wright, Trauma Care Pre-Hospital Manual, 2018
Ian Greaves, Keith Porter, Chris Wright
For lengthy journeys to definitive care there is an increased risk of tissue pressure injuries caused by immobility and unchanged pressure contact points with the scoop stretcher. In these situations a vacuum mattress will conform to the patient’s body distributing contact pressure more evenly. In addition patients report a greater degree of comfort.
Strategic medical evacuation – The critical care air support team
Published in Ian Greaves, Military Medicine in Iraq and Afghanistan, 2018
During both conflicts, it was standard practice to transfer patients on a vacuum mattress. This helped secure the patient, any indwelling lines and monitoring equipment and allowed easier movement from bed to stretcher. It also helped splint injured limbs and immobilise the spine. An area of potential concern on long strategic transfers however, was the potential for skin breakdown and the development of pressure sores. Regular rolling and inspection were mandated to prevent this. Nonetheless, following feedback from RCDM, a gel head ring was introduced to reduce the incidence of occipital alopecia.16 Another area of concern was the potential for endotracheal cuff pressure to vary with altitude. Given that elevated pressures reduce mucosal blood flow and increase the frequency of tracheal stenosis, intermittent cuff monitoring was routinely conducted.
Critical Care Flight Nurses' role within secondary aeromedical services and the inter-hospital transfer of patients with acute spinal cord impairment
Published in Contemporary Nurse, 2023
There is clinical equipoise regarding the use of hard cervical collars in patients with a hypoxic or TBI due to the risk of causing secondary brain injury (Nolte et al., 2019; Sundstrom et al., 2013). This is significant, given 25% of patients with traumatic SCI have a co-existing TBI (American College of Surgeons, 2018). Specifically, hard cervical collars have been associated with increased ICP by up to 4.5 mmHg due to impaired venous drainage, impaired respiratory function, increased aspiration risk, decreased intubation view by one grade as well as increased pain, discomfort and pressure injuries (Fenwick, 2017; Sundstrom et al., 2013). As seen in Figure 1, an alternative method of immobilisation for patients with a CSI and a coexisting TBI, involves using a vacuum mattress along with head blocks and head straps to prevent neck flexion and lateral rotation. In isolated CSI, the use of a vacuum mattress enables the head of the stretcher to be elevated to 15 degrees, improving both venous drainage and ventilation (Nolte et al., 2019; St John. Clinical Procedures and Guidelines, 2016-2018). Professional guidelines and expert opinion are increasingly advocating for professional judgement and an individualised approach to the immobilisation of the spine (Nolte et al., 2019; Queensland Ambulance Service, 2019; St John. Clinical Procedures and Guidelines, 2016-2018). This highlights that CCFN must individually assess every patient, every injury and every retrieval for indications to transport without a hard cervical collar.
Robotic laser position versus freehand in CT-guided percutaneous microwave ablation for single hepatocellular carcinoma (diameter < 3 cm): a preliminary study
Published in International Journal of Hyperthermia, 2022
Yuru Dong, Guisheng Wang, Jingjun Zhang, Shu Zhang, Xiaoxia Chen, Qing Guo, Feihuan Qu, Feng Shou
A supine or prone position was selected according to the intrahepatic lesion’s location in the liver, and local anesthesia with 1% lidocaine anesthesia were performed for all patients. On this basis, a vacuum mattress was used to avoid patient movement. The operations were performed with a 64–multidetector row CT system (Philips Medical Systems, Best, The Netherlands). The scanning layer was thick using 1 mm thin layers, and all patients underwent preoperative respiratory training before MWA. The flowchart of robot-guided MWA is shown in Figure 3, which mainly included three parts as follows: (i) preablation planning; (ii) intraoperative navigation, and (iii) postablation assessment. First, a virtual antenna simulates the needle trajectory in the liver structure with an ellipsoidal virtual thermal field appearing at the arrow’s tip on the selected CT image. The thermal field shape is formed based on the time and power of the actual MWA process. According to the preablation planning, intraoperative navigation of the robot was performed as soon as. A laser beam with a fixed angle was used to guide the interventional radiologists to puncture, avoiding the collision with the ribs and major vessels. After the above operation, one tumor map was used to evaluate the complete ablation and ablation margin. The application scenario of robot-assisted CT-guided MWA for a patient with HCC is shown in Figure 4.
Online adaptive MR-guided stereotactic radiotherapy for unresectable malignancies in the upper abdomen using a 1.5T MR-linac
Published in Acta Oncologica, 2022
Lois A. Daamen, Sophie R. de Mol van Otterloo, Iris W. J. M. van Goor, Hidde Eijkelenkamp, Beth A. Erickson, William A. Hall, Hanne D. Heerkens, Gert J. Meijer, I. Quintus Molenaar, Hjalmar C. van Santvoort, Helena M. Verkooijen, Martijn P. W. Intven
A dose of 35 Gray (Gy) was administered in five fractions to all patients who were treated before June 2019. Hereafter, the dose regimen was increased to 40 Gy in five fractions, based on initial experiences and national consensus. Fractions were spread over a period of 2 weeks, with at least 1 day between each fraction. For pretreatment imaging, a planning CT scan (Philips, Brilliance Big Bore CT) and MR-sim (1.5 T Philips ingenia MR-RT) of the entire upper abdomen was performed. The planning-CT protocol consisted of a four-dimensional (4 D) CT and an intravenous contrast-enhanced CT with an arterial and a portal venous phase, with a slice thickness of 3 mm and voxel size of 1.37 × 1.37 × 3 mm. For MRI, a 3 D T2 weighted (T2w) scan, dynamic T1 weighted sequential with and without intravenous contrast, and diffusion-weighted imaging (DWI) were acquired. Patients were positioned on a vacuum mattress (BlueBAG, Elekta AB, Stockholm, Sweden) in a head-first supine position with the arms along the body. A custom-made abdominal plaster corset was used to reduce breathing-induced tumor motion [19]. Patient setup was indexed to a special table overlay used for CT acquisition [20]. Tattooed skin marks were placed on the patient for reproducibility of the desired treatment position during treatment delivery.