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Related Concept Videos

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

388
Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
388
Flail Chest-II01:26

Flail Chest-II

161
Managing flail chest, a condition characterized by a segment of the chest wall moving independently from the rest of the thoracic cage, requires a comprehensive approach. It includes a thorough assessment of the patient's condition, a diagnostic evaluation to determine the extent of the injury, and the implementation of appropriate medical interventions tailored to the individual's needs.
Assessment:
1. Clinical Evaluation:
History:
161
Flail Chest-I01:24

Flail Chest-I

161
Overview of Flail Chest
Flail chest is a severe and potentially life-threatening condition characterized by the fracture of three or more adjacent ribs in multiple places. It is most commonly caused by direct impacts and trauma, such as motor vehicle accidents or injuries from a steering wheel impact. It can also occur due to falls in elderly individuals with osteoporosis, or assaults involving sharp objects.
Pathophysiology
The pathophysiology of flail chest is complex, involving fractures of...
161
Anticoagulant Drugs: Low-Molecular-Weight Heparins01:30

Anticoagulant Drugs: Low-Molecular-Weight Heparins

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Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
672
The Thoracic Cage: Ribs01:20

The Thoracic Cage: Ribs

2.7K
Ribs are curved, flattened bones forming the thoracic cavity wall with the thoracic muscles. There are 12 pairs of thoracic ribs. The posterior ends of all the ribs articulate with the T1–T12 thoracic vertebrae. In contrast,the anterior ends of most ribs attach to the sternum via their costal cartilages.
Parts of a Typical Rib
A typical rib has a head, neck, and body. The posterior end of the rib is called the head, followed by a narrow neck. The head articulates primarily with the costal...
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Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

Local Anesthetics: Clinical Application as Spinal Anesthesia

614
Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
614

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Updated: Jun 21, 2025

Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
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Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device

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Paravertebral Block for Multiple Rib Fractures in an Anticoagulated Trauma Patient.

Malcolm Lee1, Michael Ayad2, Jose L Diz Ferre3

  • 1Outcomes Research, Ohio University Heritage College of Osteopathic Medicine, Cleveland, USA.

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Summary

This case report details the challenging pain management for a patient with multiple comorbidities after a fall. It highlights the critical care interventions, including paravertebral catheters, for managing severe injuries and complex analgesia needs.

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alcohol use disorder (aud)direct oral anticoagulant therapymultiple rib fracturesparavertebral block (pvb)trauma patient

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Area of Science:

  • Pain Management
  • Trauma Care
  • Critical Care Medicine

Background:

  • A 52-year-old male with atrial fibrillation, essential trigeminal neuralgia, cardiomyopathy, and heart failure presented after a fall.
  • The patient had a history of multiple complex medical conditions requiring careful medication management.

Observation:

  • The patient sustained a head injury, rib fractures, and hemothorax following a fall from a motorized bicycle.
  • Initial assessment revealed intoxication with ethanol, cannabinoids, and oxycodone.
  • Physical examination showed cephalohematoma and elbow hematoma.

Findings:

  • Complex analgesia management was initiated for severe traumatic injuries.
  • Right paravertebral catheters were placed in the intensive care unit (ICU) for pain control.
  • The patient's pre-existing conditions complicated the pain management strategy.

Implications:

  • This case underscores the importance of tailored analgesia strategies in patients with multiple comorbidities and traumatic injuries.
  • Effective pain management in the ICU is crucial for recovery and preventing complications.
  • The management highlights the multidisciplinary approach required for complex trauma cases.