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Archive for the ‘Deep Vein Thrombosis’ Category

http://www.abc.net.au/news/stories/2008/03/26/2200043.htm

Contaminated anti-clotting drug recalled

The company which makes the anti-clotting drug Heparin says it has moved quickly to recall the contaminated products.

The Therapeutic Goods Administration has issued a safety warning after allergic reactions to the intravenous drug were reported in the United States.

So far, there have been no cases in Australia.

Dr Paul Bennett, from the Australian distributor Astra Zeneca, says only intravenous Heparin products have been recalled after they were found to be contaminated.

“We hope that those people will realise that this drug may present a problem,” he said.

“If they would like to go back to their pharmacist or to the doctor then they will get appropriate advice on what to do in this situation.”

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NSW rejects RNS emergency recommendation

The New South Wales Government has accepted 43 of the 45 recommendations made by a committee looking into Sydney’s Royal North Shore (RNS) Hospital, but says it will not support a recommendation to change the way emergency patients are sorted.

The inquiry was launched after a number of serious issues at the RNS, including the miscarriage of Jana Horska in the hospital’s emergency department toilets after she waited two hours for treatment.

The Upper House committee, chaired by Christian Democrats MP Reverend Fred Nile, handed its report to the Government five days before Christmas.

The report identified problems including an unacceptable tolerance of workplace bullying, a disconnect between management and staff, and a shortage of nurses.

There were also revelations during the inquiry about live cockroaches in operating theatres and beds collapsing during surgery.

Health Minister Reba Meagher says one of the recommendations not supported by the Government involved modifications to the triage system.

“This is not a decision for Government, nor is it a decision for management,” she said.

“The method of triage is one that has been established by the informed decision making of the Australasian College of Emergency Physicians.

“The Government has noted that recommendation and referred it to the Australasian College for their consideration.”

Ms Meagher says there have already been significant improvements at the hospital over the past few months.

“Every week, the performance of Royal North Shore Hospital has been improving and we’re determined to see that change continue,” she said.

“The recommendations that have been brought forward by the Nile inquiry will inform and add to that process.”

But Opposition’s health spokeswoman Jillian Skinner says low morale and understaffing are still major problems at the hospital.

“This hospital needs more nurses, it’s short of beds still, it needs specialist doctors and they’re all tearing their hair out about what they see as flawed redevelopment plans,” she said.

“This is a Minister who is clearly out of her depth.”

A special commission of inquiry was called last month into the NSW health system, after the deputy state coroner found the RNS caused the death of a 16-year-old when it made every conceivable error in its treatment.

The girl, Vanessa Andersson, died at the hospital in 2005, two days after she was admitted for a skull fracture she suffered when she was hit by a golf ball.

The coroner, Carl Milovanovich, found the teenager died of respiratory arrest due to the effect of the medication she was administered. The inquest heard anaesthetist Sanaa Ismial gave Miss Anderson the wrong dose of a painkiller.

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Climate change ‘will increase health risk’ to rural Australians

Mounting evidence of global warming has led experts to warn of greater health risks for Australians who live in rural and remote areas.

A paper from the Department of Public Health at the University of Adelaide warns altered weather patterns will bring changes in the distribution of diseases.

The paper predicts climate change will mean variations in the rates of hospital admissions and the use of ambulance services.

National Rural Health Alliance executive director Gordon Gregory says global warming could make people in remote regions more vulnerable.

“What we’ve got here is a paper which is very timely in terms of reminding us that we must have health work force on the ground to enable us to prepare for a new pattern of disease,” he said.

‘We must also have public awareness that change is afoot, so that we can be ready and willing on every front.”

“Disease patterns vary according to climate conditions because some vectors for diseases can’t survive in the hot, or in the cold, or in the wet, or in the dry.

“It’s clear that if there is any change in the pattern of weather, of climate, of the incidence of climatic events, there will be a change in the distribution of illnesses and disease.”

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Amputation


What is amputation?

In an amputation, a surgeon removes a limb, or part of a limb, that is no longer useful to you and is causing you great pain, or threatens your health because of extensive infection. Most commonly, a surgeon removes your toe, foot, leg, or arm. Physicians consider amputation a last resort.Although amputations may be required for other reasons, such as severe injury or the presence of a tumor, the most common reason you may need an amputation is if you have peripheral arterial disease (PAD) due to atherosclerosis (hardening of the arteries). In PAD, the blood vessels in your limbs become damaged because of hardening of the arteries or diabetes. Your body’s cells depend on a constant supply of oxygen and nutrients from your blood. If your blood vessels are unable to deliver blood and oxygen to your fingers or toes, the cells and tissues die and are vulnerable to infection. If the blood supply cannot be improved sufficiently or if the tissue is beyond salvage, extensive tissue death may require amputation, especially if you are experiencing severe pain or infection.How do I prepare?Your physician will perform a physical examination to determine whether your limb can be saved or if you need an amputation. He or she will check you for:

Fever
Cool skin near your wound
Extremely painful skin
Wound odor
Infected or non-healing sores or wounds

Your physician will also arrange for tests to see how well blood is reaching your limbs. These tests may include blood pressure tests, duplex ultrasound, and angiography.If you have any other conditions, such as diabetes, high blood pressure, heart problems, poor kidney function, or infections, your physician will discuss with you how to treat them to get you in the best condition. Your physician will also test your physical strength, balance, and coordination to assess your potential for rehabilitation. If you are going to use an artificial limb, sometimes your physician may arrange for you to be measured for the device before your operation. This way, your artificial limb will be ready as soon as you recover. Often, however, your physician may advise waiting until your incision is healed adequately before getting your artificial limb. You also may receive counseling before your surgery to help you adapt to the loss of your natural limb.Your physician will discuss with you whether to reduce or stop any medications that might increase your risk bleeding or other complications. If you have any allergies to anesthesia, pain medications, or antibiotics, you should tell your physician at this time.When do I need amputation?Most people who require an amputation have PAD, a traumatic injury, or cancer.PAD is the leading cause of amputation in people age 50 and older, and accounts for up to 90 percent of amputations overall. Normally, surgeons treat advanced PAD through other methods, like controlling infection using antibiotics and draining or removing any infected tissue as well as performing surgery or other procedures to increase the blood flow to the affected area. However, if these treatments do not work, amputation will remove a source of major infection and may be necessary to save your life.A traumatic injury, such as a car accident or a severe burn, can also destroy blood vessels and cause tissue death. As a result, infection if not adequately treated, can spread through your body and threaten your life. Your medical team will make every effort to save your limb by surgically replacing or repairing your damaged blood vessels or using donor tissue. However, if these measures do not work, amputation can save your life. Traumatic injuries are the most common reason for amputations in people younger than age 50.Your physician may recommend amputation if you have a cancerous tumor in your limb. You may also receive chemotherapy, radiation, or other treatments to destroy the cancer cells. Depending upon the particular circumstances, these treatments can shrink the tumor and may increase the effectiveness of your amputation.Am I at risk for complications during amputation?If you have other conditions, like diabetes or heart disease, you have a higher risk of complications from an amputation. Having a very serious traumatic injury also increases your risk of complications. Above-the-knee amputations can be associated with more risk than below-the-knee amputations, because people who require above-the-knee amputations are more likely to be in poorer health. Depending upon your particular situation, your physician will attempt to save as much of your limb as is possible.What happens during amputation?To perform an amputation, your physician must remove your diseased limb but preserve as much healthy skin, blood vessel, and nerve tissue as possible.Choosing the incision site is important. If your surgeon removes too little tissue, your wound will not heal because unhealthy tissue remains and the circulation at that level may not be sufficient for healing. To determine how much tissue to remove, your physician will check for a pulse at a joint close to the site. He or she will also compare the skin temperatures in the diseased limb with those in a healthy limb, and note places where the skin appears red, since an incision made through reddish skin may be less likely to heal. Your physician will also check that your skin around the proposed incision point still has sensitivity to touch. Finally, after he or she makes the initial cut, your physician may decide that more of your limb needs to be removed if the edges of your skin do not bleed enough to allow them to heal.Before the procedure begins, your anesthesiologist will either put you to sleep, called a general anesthetic, or numb your body in the region of the amputation, called a regional anesthetic. You will be connected to machines that monitor your heart rate, blood pressure, temperature, and brain function. When the anesthetic has taken effect and your are not able to feel the pain, your surgeon then cuts into your skin, leaving enough healthy skin to cover your stump for better healing.When your surgeon then cuts through the muscles, he or she may shape them, to make sure that your stump has a comfortable contour for your artificial limb. Your surgeon also divides and protects your nerves, so that they are not exposed and painful.During your surgery, clamps are applied to minimize bleeding when the surgeon divides the healthy major blood vessels. Before finishing your amputation, your surgeon will stitch the vessels, and then release the clamps to ensure that all bleeding points are secure.If you have a traumatic injury, your surgeon will remove the crushed bone and other tissue. Your surgeon then will smooth the uneven areas of your bone to prevent pain once you receive your artificial limb. If necessary, your surgical team may then install temporary drains that will drain your blood and other fluids.When your surgeon has completely removed all of the dead tissue, sometimes depending upon the circumstances, he or she may decide to leave the site open (open flap amputation) or to close the flaps (closed amputation). In an open flap amputation, your skin remains drawn back from the amputation site for several days so your surgical care team can clean off of any questionable or infected tissue. Once the stump tissue is clean and free of infection, the skin flaps are sewn together to close the wound, a procedure called delayed closure. In a closed amputation, the wound is sewn shut immediately. A closed amputation is usually done if your surgeon is reasonably certain that the chance of infection is small.Your surgical care team may place a stocking over your stump to hold drainage tubes and wound dressings, or your limb may be placed in traction, or a splint, depending upon your particular situation.What can I expect after amputation?After your surgery, you will stay in the hospital for approximately 5 to 14 days, depending upon your particular situation. Your physician may teach you how to change your wound dressings, or the hospital staff will change them for you. Your physician usually checks the progress of your wound in about 7 to 10 days or as oftent as necessary. Your physician will also monitor any conditions you have that might slow your healing, such as hardening of the arteries or diabetes. If you need pain medications or antibiotics, your physician will prescribe them. Ideally, your wound should fully heal in about 4 to 8 weeks after your surgery.If your condition permits, ideally, you will receive physical therapy soon after your surgery. Physical therapy includes gentle stretching for the first 2 or 3 days. Later, you will perform exercises, such as getting in and out of your bed or in and out of your wheelchair. Eventually, you will learn how to bear your weight on your remaining limb.Depending upon your particular situation, you may also begin to practice with your artificial limb as early as 10 to 14 days after your surgery, but this depends upon your comfort and wound healing progress.You may experience phantom pain (a sense of feeling pain in your amputated limb) or other emotional concerns, such as grief over the lost limb, after surgery. If this is the case, your physician can recommend counseling or drug therapy, as appropriate.Are there any complications?You may have complications following any surgical procedure. Complications that occur specifically from amputation include a joint deformity called contracture, a severe bruise called a hematoma, death of the skin flaps (necrosis), wound opening from poor healing, or infection. Your surgeon or physician can treat all of these complications. Rarely, you may need to undergo further surgical treatment or another amputation.What can I do to stay healthy?If your wound has healed well and your artificial limb fits you, your amputation should cause you minimal long-term medical concerns. However, if you have PAD, amputation does not stop plaque from building up in your remaining arteries. To prevent hardening of the arteries from affecting other parts of your body, including your heart, you should consider the following changes:

Eat more foods low in saturated fat, cholesterol, and calories
Exercise regularly
Maintain your ideal body weight
Avoid smoking

You can learn how to adapt to having an artificial limb, including getting regular exercise, with the help of physical therapy. Studies have found that amputees who engage in regular physical exercise feel better about themselves than those who are more sedentary. Also, people who recover from an amputation are more likely to have greater job satisfaction, possibly because of changes in their attitudes regarding life goals.

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OFFICE workers are more at risk of developing deep vein thrombosis (DVT) than passengers on long-haul flights, according to startling new research.

Sitting immobile at a desk for hours at a time will be revealed as a serious risk factor for so-called “economy class syndrome”.

A study – due to be presented at the annual conference of the Thoracic Society of Australia and New Zealand later this month – has found prolonged immobility at work is the most common factor shared by DVT patients.

Researchers found one in three people attending an outpatient clinic reported sitting for eight hours or longer before suffering a venous thromboembolism, whereas only one in five had travelled on a long-haul flight.

The worst-affected were managers, IT workers and taxi drivers, according to the research from the Medical Research Institute in Wellington, New Zealand.

Latest figures show Australians work among the longest hours in the world, with many spending more than 50 hours a week at their desk and almost a third regularly working on weekends.

DVT is the formation of a blood clot in a deep vein, most commonly in the legs, which may cause death if untreated.

Symptoms include pain, swelling, redness and dilated surface veins seen on the skin.

Immobility from sickness or post-surgery, taking the oral contraceptive pill, obesity and air travel are among other risk factors.

Reg Lord, professor of surgery at the University of Western Sydney and a leading expert in thrombosis, told The Sunday Telegraph that sedentary workers were at risk because the sitting position impeded blood flow.

“With IT workers or secretaries, if you get someone in a sitting position and look at the blood flow in their veins, you can see it is reduced,” he said.

“If they stay there for significant periods of time with limited leg movement, they will be at increased risk.”

But Prof Lord said workers would generally feel warning signs such as stiff or fidgety legs that should encourage them to get up and move around.

“Taxi drivers should get out of their car every now and then and go for a walk and office workers should get up and move about every hour or so,” Prof Lord said

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