Can Blood Be Compulsorily Administered under the Mental Health Act 1983?
Robert Wheeler in Clinical Law for Clinical Practice, 2020
The question as to whether an Advance Decision to Refuse Treatment (ADRT) can be used to refuse blood transfusion was answered in a case heard in 2014. In February 2014, Resuscitation Council (RC) deliberately lacerated his brachial artery and had since attempted to reopen that wound a number of times. This led to his compulsory admission to the secure hospital a month later, together with the use of a restraint belt to prevent him slashing the artery. The court found that RC suffered from a personality disorder rendering him antisocial and emotionally unstable. He cut himself with the intention of providing a distraction from distressing thoughts and feelings, particularly when severely distressed. Section 63 of the Act provides for, among other things, compulsory treatment of physical disease only if this is a symptom or manifestation of the mental illness for which the patient has been compulsorily detained.
Venous Anatomy
James Michael Forsyth, Ahmed Shalan, Andrew Thompson in Venous Access Made Easy, 2019
The dorsal venous arch lies on the central aspect of the dorsum of the hand. It receives tributaries from the dorsal metacarpal veins. The brachial vein is a deep vein in the arm; this vessel is paired closely with the brachial artery and median nerve. The basilic and brachial veins join to form the axillary vein. The axillary vein continues behind the clavicle as the subclavian vein. The great saphenous vein begins on the medial aspect of the dorsum of the foot. It runs in front of the medial malleolus, then along the medial aspect of the leg a hand's-breadth behind the medial aspect of the patella. It ends by joining the femoral vein at the sapheno-femoral junction 4 cm below and lateral to the pubic tubercle. The short saphenous vein begins on the lateral aspect of the dorsum of the foot, courses around and behind the lateral malleolus, and runs upwards along the middle aspect of the posterior leg.
Upper Limb
Bobby Krishnachetty, Abdul Syed, Harriet Scott in Applied Anatomy for the FRCA, 2020
This chapter is intended to cover the anatomical knowledge of upper limb that helps trainee anesthetists who are revising for the Primary and Final FRCA exams. The topics of importance to anesthetists are presented under 'structures', 'circulation' and 'nervous system'. The chapter includes a wide range of questions of clinical relevance that are asked in the exam. The upper limb is divided into the shoulder, arm, forearm (between elbow and wrist) and hand. The axilla, cubital fossa and carpal tunnel are important areas of transition in the upper limb. The cubital fossa is a triangular depression anterior to the elbow joint. The brachial artery divides into the radial and ulnar artery at the antecubital fossa between the two heads of the biceps. The venous drainage of the upper limb can be divided into the superficial and the deep system. The superficial venous system lies in the subcutaneous tissue and drains into the deep venous system via perforating veins.
Brachial artery stiffening in healthy primigravidas is associated with weight gain and increased cardiac output
Published in Hypertension in Pregnancy, 2018
Nancy Anderson Niemczyk, Janet M. Catov, Mansi M. Desai, Candace K. McClure, James M. Roberts, Akira Sekikawa, Ping Guo Tepper, Emma Barinas-Mitchell
Objective: To assess brachial artery distensibility and associated factors in healthy primigravidas. Methods: We assessed brachial artery distensibility using the DynaPulse 5,000A in 37 women each trimester, and 6–8 weeks and 1–5 years postpartum. Associations with physical and cardiometabolic measures were considered. Results: Mean (SE) brachial artery distensibility (%Δ/mmHg) decreased (stiffened) from 7.50 (0.20) 12–14 weeks to 6.93 (0.22) 36–38 weeks (p
Brachial Artery Pseudoaneurysm: a Rare Complication after Haemodialysis Therapy
Published in Acta Chirurgica Belgica, 2005
S. Yildirim, T. Zafer Nursal, T. Yildirim, A. Tarim, K. Caliskan
Haemodialysis patients carry a high risk of pseudoaneurysm due to inadvertent puncture of the brachial artery during venous cannulation for haemodialysis. Signs and symptoms are pulsatile mass and a systolic murmur. Complications are rupture, infection, haemorrhage, distal arterial insufficiency, venous thrombosis and neuropathy. Early diagnosis is essential to plan adequate treatment. Doppler US and angiography usually confirm the lesion accurately. Ultrasound guided compression, percutaneous injection of thrombin, endovascular covered stent exclusion, aneurysmectomy and surgical repair are different treatment options. We report clinical and radiological findings and treatment strategies in four dialysed patients who developed brachial artery pseudoaneurysms.
Clinical correlation of brachial artery flow-mediated dilation in patients with systemic sclerosis
Published in Modern Rheumatology, 2014
Takehiro Takahashi, Yoshihide Asano, Eisuke Amiya, Masaru Hatano, Zenshiro Tamaki, Munenori Takata, Atsuko Ozeki, Aya Watanabe, Shuichi Kawarasaki, Takashi Taniguchi, Yohei Ichimura, Tetsuo Toyama, Masafumi Watanabe, Yasunobu Hirata, Ryozo Nagai, Issei Komuro, Shinichi Sato
Objective To investigate the clinical significance of flow-mediated dilation (FMD) in systemic sclerosis (SSc). Methods Thirty-three SSc patients and 12 healthy controls were studied. Ultrasound assessment of the brachial artery FMD was performed on all subjects. The results were expressed as the percentage of increase in brachial artery diameter following hyperemia. Results Limited cutaneous SSc (lcSSc) patients had significantly lower FMD values than healthy controls (5.3 ± 2.7 versus 7.7 ± 2.0 %, p < 0.05), while the values in diffuse cutaneous SSc (dcSSc) patients (6.7 ± 4.0 %) were comparable to those in lcSSc patients and healthy controls. Although FMD values did not correlate with any clinical features in dcSSc patients, there was an inverse correlation between FMD values and disease duration in lcSSc patients (r = −0.64, p < 0.05). Furthermore, lcSSc patients with decreased FMD values showed significantly higher prevalence of digital ulcers and elevated right ventricular systolic pressure than those with normal values (for each; 75 versus 10 %, p < 0.05). Conclusion The FMD values represent the severity of vascular damages, which progress along with disease duration and lead to digital ulcers and pulmonary arterial hypertension, in lcSSc patients.
Related Knowledge Centers
- Arteries
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- Radial Artery