Intraoperative Cardiac Free Wall Rupture
Free wall rupture...yes we can save them
Following a syncope event, a 72-y old male was brought to the ER, stable on arrival with no history of cardiac diseases, ECG showed normal sinus rhythm, ST depression and elevated Troponin T. The patient described back pain 3 days prior with no other complaints.
ECHO revealed pericardial effusion, CT ANGIO ruled out aortic dissection while pericardial effusion and an infract of the LV at Circumflex territory were noticed.
Therefore, the patient was taken to the OR for post MI free wall rupture repair.
As expected at induction the patient collapsed and the team had to crash into the chest. Once the pericardium was opened, and the clots and blood were evacuated (tamponade was relived) no hemodynamically recovery occurred.
As continuous red (and not dark) blood was still accumulating, the heart was lifted and the tear seen in Video was spotted.
CPB was commenced and the heart was arrested for repair.
The tear was repaired using felt strips and a few single 4-0 prolene, sewing healthy tissue to healthy tissue, going beyond the infract and taking big “bites”; a pericardial patch and bio-glue were used as a second layer.
Once no bleeding was confirmed the patient was weaned from CPB and brought to the ICU.
The patient was discharged home 10 days post-op in good condition with no neurological damage.
- Dr. Yaron Barac @BaracYaron
#FreeWall #Rupture #Intraoperative #Cardiac #cardiothoracic #surgery #clinical #video
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Orthopedic Platings, Nails and Screws
Bohler’s Stirrup: U shaped device to hold a Steinmann pin and applying traction
Crutchfield Tongs: To apply skull traction in case of cervical injury
Gigli Saw: Twisted wire bone saw, use to cut bone during amputation
Cortical and Cancellous Screws: Used either itself (as lag screw) or with plates, they are non tapping screws, thread tapping should be done in the bone with bone tap
Malleolar Screws: Are self tapping screws
Dynamic Compression Plate (DCP): Exerts axial compression over fracture site by combining screw hole geometry while screw insertion.
- Broad – humerus, femur
- Narrow – tibia, forearm, pelvis
Low Contact Dynamic Compression Plates: Designed to limit vascular compromise by decreasing
plate-to-bone contact
Reconstruction Plates: Have notches alongside the plate, which enables bending in 3 dimension to contour towards complex surfaces easily
Buttress Plating: (Fr – to strike/shoke) The plate serves to push or buttress the split tibial plateau fragment against displacement and depression.
- T and L plates are designed to be used as buttress plates
Dynamic Hip Plate/Screw: Used in intertrochanteric fracture of femur
Dynamic Condylar Plate/Screw: Used in distal end femur fracture (unicondylar/intercondylar)
Angle Blade Plates: 95°-angled plates are used in the repair of metaphyseal fractures and reconstruction of the femur. It provides very rigid fixation.
- Condylar- distal femur, intertrochanteric/sub-trochanteric fracture.
- Double angled – femoral valgus repositioning osteotomy
Illizarov External Fixators: For limb lengthening, arthrodesis, deformity correction and infected
non-union
Hip Prosthesis: Used for replacement of head of femur following NOF fracture. Help patients to early mobilise and eliminate complication such as AVN, non union, fixation failure
- Austin Moore – used in NOF fracture with calcar femorale intact, no osteoporosis; prosthesis has neck, collar and holes, bone cement is not required during application
- Thompson – used in NOF fracture with no calcar, with osteoporosis; prosthesis has NO neck, collar and holes, bone cement is required during application
- Bipolar – used in yiounger patients with non union of femoral neck. It has low incidence of protrusio acetabuli
#Platings #Nails #Screws #Orthopedics #management #indications #hardware #equipment
Extensor Carpi Ulnaris (ECU) subluxation
The Extensor Carpi Ulnaris (ECU), is the must ulnar of the muscles of the forearm, and extends from the elbow to the hand, where it joins by inserting into the fifth metacarpal, the bone that leads to the little, or pinky, finger. As the ECU shifts into a tendon and joins the bones of the hand, it passes through a fibrous tunnel at the base of the ulna, and when this sheath is injured, the tendon can be affected. .
When the tendon occupies the wrong space within the sheath or is moved to an extreme degree within this sheath, it is known as subluxation.
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What causes ECU Subluxation? ECU subluxation is caused when the fibrous sheath through which the ECU tendon passes upon reaching the wrist joint become injured, whether through trauma or repetitive injury. Inflammation of the sheath can cause the tendon to become displaced, and more serious injury to the sheath might become torn, and the tendon may then exit the sheath entirely.
What are the symptoms of ECU Subluxation? ECU subluxation most often presents with a searing pain to the affected area, being the ulnar aspect of the wrist. Snapping can also be felt, as the misplaced tendon interacts with the bones of the wrist where it has been moved. The displacement of the tendon is also often visible upon physical examination of the injured area.
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How is ECU Subluxation diagnosed?
The subluxation of the ECU tendon may be visible to the naked eye after a physical examination of the injury. Palpation and movement of the joint may also give a better understanding of the possible nature of the injury. In order to determine the full extent of the injury to the sheath and to ascertain the exact position of the ECU tendon, MRI or ultrasound imaging are used to look inside the wrist and locate all of the relevant body parts.
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What is the Treatment ?
Non surgical treatment consists of physical therapy (patient’s education, activity modification, exercises) and splinting may be considered during the initial stage.
Panagiotis Arsenis @rarephysio
#Extensor #Carpi #Ulnaris #ECU #subluxation #clinical #physicalexam #video #Orthopedics #Wrist #msk
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Bronchoalveolar Lavage (BAL) on Bronchoscopy
BRONCHOALVEOLAR LAVAGE is a technique used in bronchoscopy for several diagnostic purposes. For example, if there is concern for an infectious process in the right middle lobe, the scope can be wedged in one of the segments in the right middle lobe and a BAL can be done. The bronchoscope is directed into a smaller airway of concern (guided by chest imaging), and it is “wedged” into the small airway. A proper wedge is noted when the airway collapses when suction is applied.
Once wedged, sterile normal saline is inserted into a subsegment of the lung, followed by suction and collection of the instillation for analysis.
This simple procedure can help a pulmonologist in several ways as noted below!
— Infection
— Diagnosing sarcoidosis
— Diffuse Alveolar Hemorrhage (DAH)
— Pulmonary Alveolar Proteinosis (PAP)
— Eosinophilic Pneumonia
— Hypersensitivity Pneumonitis (HP)
— Some (but often not helpful) Interstitial Lung Diseases (ILDs)
— and even occupational exposures!
This is a video of a bronchoscope wedged into a subsegment of the lung with instillation of saline for the BAL.
Dr. Komal Parikh @pulmcritdoc
#Bronchoalveolar #Lavage #BAL #Bronchoscopy #clinical #video #pulmonary
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