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What Is Hemodialysis and How Does It Work? Scott 65 Views • 2 years ago

What is hemodialysis and how does it work? Who needs it? How do you prepare for it? In the United States, over 30 million Americans have kidney disease, and sometimes, kidney disease progresses to kidney failure or end-stage renal disease. When this happens, you cannot survive unless you have a kidney transplant or some form of dialysis. So today we're going to talk about hemodialysis.

Your kidneys are the two kidney bean-shaped organs that are located in your lower back, or in your flanks. And the kidneys are responsible for filtering out or cleaning your blood. They get rid of excess waste, excess toxins, and excess fluids. If your kidneys stop functioning, then you develop renal failure or end-stage renal disease.

What is Hemodialysis?
Hemodialysis, or blood dialysis, is the filtering of your blood outside of your body. So, if your kidneys stop working properly, the hemodialysis acts as a substitute kidney. Now it's important to note that hemodialysis does not actually correct your own kidney function. It does not fix or treat your kidneys.

#hemodialysis #drfrita

What is The Dialyzer?
The dialyzer is actually the filter. It's the main powerhouse of the hemodialysis system, and it is what actually acts as the substitute kidney. In the dialyzer, you have these hollow fibers that run through it, and these fibers are bathed in something called dialysates, or dialysis fluid.

How Often Are Patients Treated With Hemodialysis?
Most patients who are on hemodialysis are on it between three and six hours, about three days a week, especially if they go to a center.

How Does Hemodialysis Work?
So when you are on dialysis, how does your blood get from your body to the hemodialysis machine and then back to your body? Well, it does so through tubes, and those tubes are connected to your access, and we'll talk about access in just a moment. But as far as the tubing, the tubing is connected to your body.

Types Of Hemodialysis Access
Arteriovenous Fistula or AV Fistula
The AV fistula is the gold standard as far as hemodialysis access is concerned because it gives you the most efficient hemodialysis and it is the least likely to be infected.

Arteriovenous Graft or AV Graft
The AV graft is very similar to the AV fistula in that you still have a surgically connected artery and a vein, usually in the arm, but in the case where if you have veins that are rather thin or arteries that are thin and maybe too weak in order to really give you a properly functioning, substantial AV fistula, then the vascular surgeon may opt to add an artificial material in order to make that shunt a little stronger, or little more durable. And so, an AV graft is another option for dialysis access.

Catheter
If you're in a situation where you need temporary dialysis, or if you have acute kidney injury, then you may have a temporary Vascath placed, and it's usually placed in a vein of the neck, the internal jugular vein, or it can be placed in the groin, or in the femoral vein.

Who Needs Hemodialysis Treatment?
How do you know if you need hemodialysis, and when is it time to prepare? Well, if you follow up with your kidney doctor (nephrologist) regularly, he or she will be watching your labs. They'll be able to see those signs of your kidneys not functioning properly.

Closed Reduction of a Distal Radius Fracture samer kareem 18,517 Views • 2 years ago

Closed Reduction of Distal Radius Fractures - Discussion: (distal radius fracture menu) - closed reduction & immobilization in plaster cast remains accepted method of treatment for majority of stable distal radius frx; - unstable fractures will often lose reduction in the cast and will slip back to the pre-reduction position; - patients should be examined for carpal tunnel symptoms before and after reduction; - carpal tunnel symptoms that do not resolve following reduction will require carpal tunnel release; - cautions: - The efficacy of closed reduction in displaced distal radius fractures. - Technique: - anesthesia: (see: anesthesia menu) - hematoma block w/ lidocaine; - w/ hematoma block surgeon should look for "flash back" of blood from hematoma, prior to injection; - references: - Regional anesthesia preferable for Colles' fracture. Controlled comparison with local anesthesia. - Neurological complications of dynamic reduction of Colles' fractures without anesthesia compared with traditional manipulation after local infiltration anesthesia. - methods of reduction: - Jones method: involves increasing deformity, applying traction, and immobilizing hand & wrist in reduced position; - placing hand & wrist in too much flexion (Cotton-Loder position) leads to median nerve compression & stiff fingers; - Bohler advocated longitudinal traction followed by extension and realignment; - consider hyper-extending the distal fragment, and then translating it distally (while in extended position) until it can be "hooked over" proximal fragment; - subsequently, the distal fragment can be flexed (or hinged) over the proximal shaft fragment; - closed reduction of distal radius fractures is facilitated by having an assistant provide counter traction (above the elbow) while the surgeon controls the distal fragment w/ both hands (both thumbs over the dorsal surface of the distal fragment); - flouroscopy: - it allows a quick, gentle, and complete reduction; - prepare are by prewrapping the arm w/ sheet cotton and have the plaster or fibroglass ready; - if flouroscopy is not available, then do not pre-wrap the extremity w/ cotton; - it will be necessary to palpate the landmarks (outer shaped of radius, radial styloid, and Lister's tubercle, in order to judge success of reduction; - casting: - generally, the surgeon will use a pre-measured double sugar sugar tong splint, which is 6-8 layers in thickness; - more than 8 layers of plaster can cause full thickness burns: - reference: Setting temperatures of synthetic casts. - position of immobilization - follow up: - radiographs: - repeat radiographs are required weekly for 2-3 weeks to ensure that there is maintenance of the reduction; - a fracture reduction that slips should be considered to be unstable and probably require fixation with (pins, or ex fix ect.) - there is some evidence that remanipulation following fracture displacement in cast is not effective for these fractures; - ultimately, whether or not a patient is satisfied with the results of non operative treatment depends heavily on th

Laparoscopic Cholecystectomy Fully Explained Skin-to-Skin Video with Near Infrared Cholangiography Surgeon 162 Views • 2 years ago

This video demonstrates Laparoscopic Cholecystectomy Fully Explained Skin-to-Skin Video with Near Infrared Cholangiography performed by Dr R K Mishra at World Laparoscopy Hospital. A laparoscopic cholecystectomy is a minimally invasive surgical procedure that involves removing the gallbladder. It is typically performed using small incisions in the abdomen, through which a laparoscope (a thin tube with a camera and light) and surgical instruments are inserted. The surgeon uses the laparoscope to visualize the inside of the abdomen and to guide the instruments in removing the gallbladder.

Near-infrared cholangiography is a technique that uses a special camera and fluorescent dye to visualize the bile ducts during surgery. The dye is injected into the cystic duct (the tube that connects the gallbladder to the bile ducts) and the camera detects the fluorescence emitted by the dye, allowing the surgeon to see the bile ducts more clearly.

The combination of laparoscopic cholecystectomy and near-infrared cholangiography has become a standard of care in many hospitals and surgical centers. It allows for a more precise and efficient surgery, reducing the risk of complications such as bile duct injury.

The use of indocyanine green (ICG) with near-infrared imaging during laparoscopic cholecystectomy has several advantages. Here are some of them:

Better visualization of the biliary anatomy: ICG with near-infrared imaging allows for better visualization of the biliary anatomy during surgery. This helps the surgeon identify important structures, such as the cystic duct and the common bile duct, and avoid injuring them.

Reduced risk of bile duct injury: With better visualization of the biliary anatomy, the risk of bile duct injury during surgery is reduced. Bile duct injury is a serious complication that can occur during laparoscopic cholecystectomy and can lead to long-term health problems.

Improved surgical precision: ICG with near-infrared imaging also improves surgical precision. The surgeon can better see the tissues and structures being operated on, which can help reduce the risk of bleeding and other complications.

Shorter operating time: The use of ICG with near-infrared imaging can shorten the operating time for laparoscopic cholecystectomy. This is because the surgeon can more quickly and accurately identify the biliary anatomy, which can help streamline the surgery.

Overall, the use of ICG with near-infrared imaging is a valuable tool in laparoscopic cholecystectomy that can improve surgical outcomes and reduce the risk of complications.

Like any surgical procedure, laparoscopic cholecystectomy (gallbladder removal) has potential complications. Here are some of the most common ones:

Bleeding: Bleeding during or after the surgery is a possible complication of laparoscopic cholecystectomy. Most cases are minor and can be easily controlled, but in rare cases, significant bleeding may require a blood transfusion or even additional surgery.

Infection: Any surgical procedure carries a risk of infection. After laparoscopic cholecystectomy, there is a risk of infection at the site of the incisions or within the abdomen. Symptoms may include fever, pain, redness, or drainage from the incision sites.

Bile leakage: In some cases, a small amount of bile may leak from the bile ducts into the abdominal cavity after gallbladder removal. This can cause abdominal pain, fever, and sometimes requires further surgery or treatment.

Injury to nearby organs: During the surgery, there is a small risk of unintentional injury to nearby organs such as the liver, intestines, or bile ducts. This can cause additional complications and may require further treatment.

Adverse reactions to anesthesia: As with any surgery requiring general anesthesia, there is a small risk of adverse reactions to the anesthesia, such as an allergic reaction, respiratory problems, or heart complications.

Most patients recover without complications following a laparoscopic cholecystectomy, but it is important to discuss any concerns or questions with your surgeon beforehand.

Contact us
World Laparoscopy Hospital
Cyber City, Gurugram, NCR Delhi
INDIA : +919811416838

World Laparoscopy Training Institute
Bld.No: 27, DHCC, Dubai
UAE : +971525857874

World Laparoscopy Training Institute
8320 Inv Dr, Tallahassee, Florida
USA : +1 321 250 7653

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