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At one time, women who had delivered by cesarean section in the past would usually have another cesarean section for any future pregnancies. The rationale was that if allowed to labor, many of these women with a scar in their uterus would rupture the uterus along the weakness of the old scar. Over time, a number of observations have become apparent: Most women with a previous cesarean section can labor and deliver vaginally without rupturing their uterus. Some women who try this will, in fact, rupture their uterus. When the uterus ruptures, the rupture may have consequences ranging from near trivial to disastrous. It can be very difficult to diagnose a uterine rupture prior to observing fetal effects (eg, bradycardia). Once fetal effects are demonstrated, even a very fast reaction and nearly immediate delivery may not lead to a good outcome. The more cesarean sections the patient has, the greater the risk of subsequent rupture during labor. The greatest risk occurs following a “classical” cesarean section (in which the uterine incision extends up into the fundus.) The least risk of rupture is among women who had a low cervical transverse incision. Low vertical incisions probably increase the risk of rupture some, but usually not as much as a classical incision. Many studies have found the use of oxytocin to be associated with an increased risk of rupture, either because of the oxytocin itself, or perhaps because of the clinical circumstances under which it would be contemplated. Pain medication, including epidural anesthetic, has not resulted greater adverse outcome because of the theoretical risk of decreasing the attendant’s ability to detect rupture early. The greatest risk of rupture occurs during labor, but some of the ruptures occur prior to the onset of labor. This is particularly true of the classical incisions. Overall successful vaginal delivery rates following previous cesarean section are in the neighborhood of 70 This means that about 30of women undergoing a vaginal trial of labor will end up requiring a cesarean section. Those who undergo cesarean section (failed VBAC) after a lengthy labor will frequently have a longer recovery and greater risk of infection than had they undergone a scheduled cesarean section without labor. Women whose first cesarean was for failure to progress in labor are only somewhat less likely to be succesful in their quest for a VBAC than those with presumably non-recurring reasons for cesarean section. For these reasons, women with a prior cesarean section are counseled about their options for delivery with a subsequent pregnancy: Repeat Cesarean Section, or Vaginal Trial of Labor. They are usually advised of the approximate 70successful VBAC rate (modified for individual risk factors). They are counseled about the risk of uterine rupture (approximately 1in most series), and that while the majority of those ruptures do not lead to bad outcome, some of them do, including fetal brain damage and death, and maternal loss of future childbearing. They are advised of the usual surgical risks of infection, bleeding, anesthesia complications and surgical injury to adjacent structures. After counseling, many obstetricians leave the decision for a repeat cesarean or VBAC to the patient. Both approaches have risks and benefits, but they are different risks and different benefits. Fortunately, most repeat cesarean sections and most vaginal trials of labor go well, without any serious complications. For those choosing a trial of labor, close monitoring of mother and baby, with early detection of labor abnormalities and preparation for
http://www.highimpact.com - This brain surgery animation was used to demonstrate a young girl's craniotomy, cranioplasty, and reconstructive skull surgery after her vehicle was struck by a tractor-trailer. The procedures included the evacuation of a large epidural hematoma, the draining of the epidural space, and the reassembly of bone fragments to repair the skull.
More Brain Surgery Animations: https://tinyurl.com/y6m4lkdf
WHAT HAPPENED
A teenage girl was riding home with her parents and boyfriend from a Wednesday night church service when a tractor-trailer struck the back driver’s side of their car as they were traveling through an intersection. The impact sent the car spinning into oncoming traffic where it struck another vehicle. When paramedics arrived, the 17-year-old was unresponsive with bleeding from her left ear and a laceration from behind her left ear.
She was rushed to the hospital where she underwent a series of CT scans that showed a severely comminuted open skull fracture with an underlying 1.1 cm subdural hematoma. She was taken to the operating room where an emergency craniotomy was performed to evacuate the hematoma and reassemble the skull fragments. The patient gradually began to wake up and was discharged six days later, after she showed she could maneuver up and down the hallway.
The biggest challenge in a traumatic brain injury case like this - where most of the damages are deeply underlying and undetectable on the surface - is that the only visual evidence is in the form of 2D black-and-white radiographic films. This can look ambiguous to the typical juror because it’s often difficult to discern where these snapshots are located inside the person’s skull. Tony Seaton, Esq., and Robert Bates, Esq., needed to reinforce this 2D radiographic evidence with maximum 3D context.
We equipped them with a custom Diagnostic Slice Chooser: an interactive presentation that presents radiographic slides within a three-dimensional model of the patient’s head. We also designed the model accurately to the patient’s likeness and colorized the films to highlight key areas of damage. The attorneys could show the complete depth and magnitude of his client’s injuries at every level both before and after the surgery. After establishing the full extent of damages, we also created an animation to walk viewers through the surgical experience the patient would undergo as a result of her injuries.
The visual presentation helped jurors understand the destructive impact this collision had on this young teenager’s life, and Mr. Seaton and Mr. Bates, Esq., were able to acquire a $4.5M settlement for his client.
Read the Full Case Study: https://tinyurl.com/yy4v2dyh
A tonsillolith lodged in the tonsillar crypt. Specialty. Otorhinolaryngology. Tonsilloliths, also known as tonsil stones, are clusters of calcified material that form in the tonsillar crypts, the crevices of the tonsils. While they occur most commonly in the palatine tonsils, they may also occur in the lingual tonsils.
It’s called gamma knife surgery, but there’s no cutting involved.
It’s been used at Mayo Clinic for 30 years as an alternative to open brain surgery.
The patient’s head is held still during the procedure with a headframe, which also serves as a map for the radiation. Using 3D imaging — typically an MRI — as a guide, the gamma knife is targeted directly at the tumor.
And with no hospital stay and minimal side effects, it’s a procedure that is efficient and can be lifesaving.
More health and medical news on the Mayo Clinic News Network. https://newsnetwork.mayoclinic.org/
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In this video, Dr. Robert Rozbruch, chief of Limb Lengthening and Complex Reconstruction at Hospital for Special Surgery performs an osseointegration after a primary amputation. The patient, a 40 year old woman, had chronic nerve pain and compromised function of her residual limb.
For more information, visit: https://www.limblengthening.com/
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https://www.youtube.com/channe....l/UC-JL_X6ALjZXiXtcP
key words: Osseointegration, Amputee, Amputation, Limb Replacement, Tibia, Osseointegration
An amputation is the removal of an extremity or appendage from the body. Amputations in the upper extremity can occur as a result of trauma, or they can be performed in the treatment of congenital or acquired conditions. Although successful replantation represents a technical triumph to the surgeon, the patient's best interests should direct the treatment of amputations. The goals involved in the treatment of amputations of the upper extremity include the following : Preservation of functional length Durable coverage Preservation of useful sensibility Prevention of symptomatic neuromas Prevention of adjacent joint contractures Early return to work Early prosthetic fitting These goals apply differently to different levels of amputation. Treatment of amputations can be challenging and rewarding. It is imperative that the surgeon treat the patient with the ultimate goal of optimizing function and rehabilitation and not become absorbed in the enthusiasm of the technical challenge of the replantation, which could result in poorer outcome and greater financial cost due to lost wages, hospitalization, and therapy.
Diastasis recti often occurs during pregnancy and can persist after pregnancy. It affects core strength and the appearance of the abdominal muscles.
Dr. Erick Sanchez repairs the abdominal muscles with every tummy tuck. This short video shows the muscle repair portion of the surgery with a bonus after photo at the end!
To request a consultation with Dr. Sanchez, visit sanchezplasticsurgery.com and click Request a Consultation. Fill out the form and someone will get in touch with you to answer all your questions.
Expected cost can be found at the bottom of each procedure page on our website.
Ellis demonstrates how to clean a reusable inner cannula, care for a tracheostomy site, and suction a tracheostomy.
Our Critical Nursing Skills video tutorial series is taught by Ellis Parker MSN, RN-BC, CNE, CHS and intended to help RN and PN nursing students study for your nursing school exams, including the ATI, HESI and NCLEX.
#ClinicalSkills #NCLEX #tracheostomy #patientcare #ATI #Kaplan #LVN #PN #RN #nurseeducator #nurse #nursingstudent #murse #clinicals #clinicalnursingskills
00:00 What to expect Tracheostomy Care and Suctioning
0:33 Explaining the process Tracheostomy Care and Suctioning
1:10 Positioning patient for a Tracheostomy Care and Suctioning
1:33 Opening tray
1:46 Pouring saline
1:58 Removing inner cannula
2:14 Removing clean gloves
2:25 Donning sterile gloves
3:16 Showing tray contents
3:53 Removing previous dressing
4:06 Pouring saline
4:27 Cleaning stoma
5:10 Cleaning faceplate
5:20 Drying site
5:30 Cleaning inner cannula
6:00 Drying inner cannula
6:20 Reinserting inner cannula
6:40 Placing new gauze
7:00 Replacing ties
8:00 Replacing oxygen
8:13 Preparing for suction
8:58 Checking suction
9:30 Opening saline
9:42 Opening kit
9:58 Donning sterile gloves
11:04 Setting up saline container
11:20 Pouring saline
11:52 Connecting catheter to suction
12:46 Inserting catheter
13:10 Removing catheter
13:24 Rinsing catheter
13:40 Reoxyginating
14:05 Reinserting catheter
14:17 Removing catheter
14:29 Rinsing catheter
14:44 Reoxyginating
14:55 Cleaning up
15:09 Chatting about sterility
17:00 Checking a tie
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reast Augmentation: From Cost to Complications || Common gynaecological problems in women Breast augmentation (aka augmentation mammaplasty) is one of the most popular cosmetic procedures performed in the U.S. today. Despite controversy over the use of silicone breast implants, women have shown a continuing and growing eagerness to surgically enhance the size and shape of their breasts. If you are a healthy, non-smoking women who are at or near their ideal weight, with enough of their own breast tissue to cover and support an implant adequately, then you are a good candidate for breast augmentation surgery.
Surgeons in London removed a woman's brain tumor during a very unusual procedure. CBS News' Tina Kraus reports, the patient's love of music helped guide the surgery.
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Hydrocele surgery — the operation that drains and repairs the fluid-filled sac around the testicle — is shown in this educational video. It outlines the main steps of the procedure for students and for patients learning about the condition. Procedure education only — not personal medical advice.