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Managing Blunt Abdominal Trauma
Published in Kajal Jain, Nidhi Bhatia, Acute Trauma Care in Developing Countries, 2023
Ajay Savlania, Venkata Vineeth Vaddavalli, Kishore Abuji
After initial resuscitation, management is based on the patient's haemodynamic status (Figure 25.1). For haemodynamically unstable patients, an exploratory laparotomy should be done. To provide adequate exposure, the abdomen is opened from the xiphoid process to the pubic symphysis. When the injuries are identified, they are repaired. The development of physiological compromise prompts the need to abbreviate the operation and proceed with the damage control method. For haemodynamically stable patients, a detailed evaluation is done with an abdominal CT. If there is a perforated hollow viscus, it should be operated upon. Haemodynamically stable patients with solid organ injury should be monitored at timely intervals with serial abdominal examinations, vital monitoring and checking for haemoglobin drop.
The Phrenic Nerves, Diaphragm and Pericardium.
Published in Fred W Wright, Radiology of the Chest and Related Conditions, 2022
Kleinman and Raptopoulos (1985) and Gale (1986 - see below) studied variations in the anatomy of the anterior part of the diaphragm as shown by CT, particularly in relation to Morgagni hemiae. From the dome arises the middle leaflet of the central tendon, which lies below the inferior surface of the heart and blends partially with the parietal pericardium. This leaflet is attached by muscle fibres to the costal cartilages and the xiphoid process of the sternum. It is commonly seen as a smooth or slightly undulating soft tissue curve, continuous across the midline and concave posteriorly. It may have a gap in its middle portion, or appear as a broad band with irregular or illdefined anterior margins. The normal position of the middle part is above the level of the xiphoid process. A 'curtain of muscle' anteriorly bounds gas or fluid collections within the peritoneal cavity and will also bound loops of large (or small) bowel which have risen in front of the liver (the 'Béclère or Chilaiditi's syndrome' - Illus. CHILIADITI'S SYNDROME). This is common in children and some elderly patients who are 'full of wind'. It may also occur in pregnancy, with emphysema, ascites, a pneumoperitoneum or an atrophic liver.
Complications of open repair of ruptured abdominal aortic aneurysm
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
One of the most important factors determining the outcome of the patient's ruptured AAA is the time elapsed between the onset of rupture and gain of proximal control.1 As induction of general anesthesia relieves the pain, relaxes the abdominal wall musculature, and releases a sympathetic tone, resulting in cardiovascular collapse,2,3 induction should be withheld until the incision is ready to be made. In the case of endovascular repair, femoral access and placement of a balloon occlusion catheter may be placed under local anaesthesia, prior to induction. A rapid transfusion protocol with blood products in the room, autologous blood recovery system (Cell Saver), and a body warmer should be available. In most patients, a long midline transabdominal incision from the xiphoid process just above the symphysis is made.2,3 In selected patients, including those with ileostomy/urinary stoma or a contained type IV thoracoabdominal aneurysm, left flank incision through the 9th or 10th intercostal space may be a better option depending on the extent of the aneurysm and the patient's body habitus.
Effects of percutaneous vertebroplasty on respiratory parameters in patients with osteoporotic vertebral compression fractures
Published in Annals of Medicine, 2022
Ching-Hou Ma, Hsin-Lun Yang, Yu-Ting Huang, Zhi-Xiang Wu, Hui-Ching Cheng, Wan-Ching Chou, Ching-Hsia Hung, Kun-Ling Tsai
The chest expansion test was selected to test the mobility of the rib cage [12,13]. While in a seated position, the patient was asked to breathe in gradually through the nose, using lung expansion to push the measuring tape as much as possible, then to breathe out through the mouth as completely as possible. The therapist measured the difference in chest circumference between the end of a complete inspiration and expiration cycle with a cloth tape. The anatomical mark was the xiphoid process, and the tenth thoracic spinous process was determined as the posterior landmark [14]. The chest mobility test was performed three times and averaged at each study time point to assure the measurement was reproducible and accurate. This method was proven to be reliable with ICCs of 0.81–0.91 (95% confidence interval, 0.69–0.99) [15].
Surgical Models to Explore Acellular Liver Scaffold Transplantation: Step-by-Step
Published in Organogenesis, 2020
Marlon L. Dias, Cíntia M. P. Batista, Victor J. K. Secomandi, Alexandre C. Silva, Victoria R. S. Monteiro, Lanuza A. Faccioli, Regina C. S. Goldenberg
CAUTION Wipe excess disinfectant with sterile gauze to avoid exposing internal organs to these disinfectants. Start isoflurane inhalation with oxygen flow at 3–4% for the induction of anesthesia during laparotomy.Do a transverse abdominal skin and muscle incision to expose the xiphoid process. Expose the abdominal cavity by retracting the lower abdominal walls bilaterally using forceps (Figure 2a).After making the transverse abdominal incision, lower the isoflurane flow to 1–2% for the maintenance of anesthesia.
Evaluation of the within- and between-day intra-tester and inter-tester reliability of positioning subjects into neutral and lordotic sitting postures
Published in European Journal of Physiotherapy, 2019
Vasileios Korakakis, Kieran O’Sullivan, Yiannis Sotiralis, Stefanos Karanasios, Vasilis Sideris, Alexandros Sideris, Konstantinos Sakellariou, Giannis Giakas
The participants were suitably disrobed to allow skin marking with pen for placement of the reflective markers over anatomical landmarks. The landmarks were located by one physiotherapist using manual palpation and verified by another. The same procedure was conducted on Day 2 after 1 week. This process of using manual palpation of landmarks and marking with ink, with confirmation by a second investigator is consistent with other studies assessing spinal posture [13, 27, 44]. The attachment of the anterior and posterior body markers was carried out while subjects were standing and the head markers while seated. Markers were applied to the pelvis over the anterior and posterior superior iliac spines, to the posterior superior body over the C7, T5, T10, L3 and S2 spinous processes [39]. Anteriorly markers were applied to the sternal notch and xiphoid process. Finally, markers were adhered to the head over the lateral margins of the orbit and over the external occipital protuberance by using an elastic band and on the main protuberance of the forehead between the eyebrows.