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The intraoperative use of hemostatic agents and tissue sealants has increased significantly recently, largely because of the increasing trend toward minimally invasive surgeries and percutaneous interventional procedures. It is estimated that they were used in 35.2% of major surgeries in 2010 [1]. Unfortunately, with this rise in use comes new potential imaging pitfalls, because misinterpretation of the findings has been shown to be extremely common if the radiologist is not aware of the presence of these agents [2]. They can be used in a diverse array of procedures and can mimic tumor or infection in any part of the body [3, 4]. Therefore, an understanding of the agents and common imaging findings is crucial in postoperative imaging.
The major types of the topical hemostatic agents include gelatin-based products, oxidized cellulose, collagen-based products, polysaccharide spheres, and fibrin sealants, the latter of which can be used in various forms as a topical hemostat, sealant, or adhesive [5–8]. There are relatively few reports of their imaging appearances after various abdominal and pelvic procedures in the literature. These agents have been most frequently described in the urologic literature, primarily after partial nephrectomies.
In this article, we discuss the imaging appearances of commonly used hemostatic agents and tissue sealants in the abdomen and pelvis with examples illustrating the most frequently encountered pitfalls. The individual agents are examined as well, although these cannot be reliably differentiated from each other on imaging. Other postoperative findings such as abdominal spacers and omental packing are briefly explored. Finally, we discuss useful ways to distinguish their normal postoperative appearance from true pathologic findings such as infection or tumor recurrence.
Effectiveness of hemostatic agents in thyroid surgery for the prevention of postoperative bleeding
Postoperative bleeding remains one of the most frequent, but rarely life-threatening complications in thyroid surgery. Although arterial bleeding is the main cause of postoperative hemorrhage, most often no actively bleeding vessel can be found during revision. Therefore, the coagulation technique for larger vessels may play a minor role, and hemostatic agents could be of higher importance. In this descriptive, retrospective study, data of 279 patients with thyroid surgery (total of 414 thyroid lobectomies) were collected. We reviewed the electronic medical record by analyzing the histological, operative, laboratory and discharge reports in regards to postoperative bleeding. Of the 414 operated thyroid lobes, 2.4% (n = 10) bled. 1.4% (n = 6) needed reoperation while the other 1.0% (n = 4) could be treated conservatively. Hemostatic patches were applied 286 (69.1%) times. Of the 128 (30.9%) patch-free operated sides, 4.7% (n = 6) suffered postoperative bleeding. Tachosil® alone was used 211 (51.0%) times and bleeding occurred in 1.4% (n = 3). Without statistical significance (p = 0.08) the use of Tachosil® seems to help preventing postoperative bleeding. The combination with other patches doesn’t appear to be more efficient.To get more news abouthemostasis, you can visit rusuntacmed.com official website.
Due to its endocrine function, the thyroid gland is a well perfused organ. For this reason, a good hemostasis during surgical procedures is of utmost importance. Postoperative bleeding remains one of the most frequent complications, and can cause airway compression and respiratory distress in severe cases. Moreover, intraoperative bleeding can obscure important structures like the parathyroid glands and the recurrent laryngeal nerve, complicating surgical dissection and increasing morbidity Aleksandar, et al.1,2,3. The frequency of postoperative cervical hematoma (PCH) in thyroid surgery requiring reoperation ranges from 0 to 9.1%4, and it is the most common reason for return to the operating room5.
Many factors influence perioperative hemostasis. In the literature, several preoperative patient’s risk factors are described, such as Grave’s disease6,7,8,9, benign pathology6,8,9, the use of anticoagulation or antiplatelet medication while doing surgery6,10, an increased size of the pathology specimen6, an emergent admission8, presence of 2 or more comorbidities8, previous thyroid surgery9, age 65 years and older7,11, African-American race7 and history of alcohol abuse7. A BMI greater than 30 kg/m2 11,12 and male sex7,9,11 are also independent risk factors associated with PCH. Furthermore, postoperative hypertension increases the risk of postoperative bleeding9,13.
In the past century, the only instruments at a surgeon’s disposal to obliterate vessels were needle and thread in order to create a ligation. Nowadays, the industry provides a variety of devices to seal and cut vessels, such as metal clips, bipolar coagulation forceps (e.g. BiClamp®) and ultrasound scissors. The type of sealing technique doesn’t seem to affect the risk of postoperative bleeding. Alesina et al. and Brzezinski et al. found no difference in complication rate by using BiClamp® or ligations in their studies. Other vessel sealing systems, like LigaSure® and Harmonic Scalpel® have proven to be efficient in safely sealing the vessels with minimal thermal effect on the surrounding tissue, but they are expensive and only meant for a single use14,15. On the other hand, many studies such as the one from McNally et al. showed no difference in comparing ultrasonic dissection devices (Harmonic Focus®) with electronic vessel sealing systems (LigaSure®) in several criteria except from operating time, which was shorter for ultrasonic devices16.
Although arterial bleeding is the main cause of postoperative hemorrhage, as it starts earlier than venous oozing. Most often no actively bleeding vessel can be found during reoperation12. Therefore, the coagulation technique for the larger vessel may play a minor role. As certain conditions, like for example the need of anticoagulant agents cannot be changed for different reasons, hemostatic agents may play an important role. Therefore, we focused on sealant patches.
Basically, there are two main categories of hemostatic patches available: biologically active and physical agents. The first group consists of sealant matrixes containing human coagulation factors as a coating on the surface. In contact with body fluids, such as blood, the components of the coating diffuse into the wound activating the fibrinogen-thrombin reaction, thus initiating the last phase of the human coagulation cascade. This process leads to the formation of a fibrin clot, which holds the collagen matrix to the wound surface, creating a mechanically stable network that provides sealing. Among the commercially available products are Surgiflo®, Floseal® (gelatin-thrombin matrix sealants), Evarrest® and Tachosil® (fibrinogen and thrombin coated matrix), the latter being most frequently used at the University Hospital of Basel (USB). The second group consists of physical agents that enhance hemostasis using a passive substrate. An oxidized cellulose patch, when saturated with blood, provides a surface for platelet adhesion and aggregation, thus initiating the formation of a durable clot that doesn’t wash away or bleed again when irrigated. Tabotamp Snow®, Spongostan™ and Nu-Knit® are examples that belong to this type of physical agents.
How to Build A Hiker's First Aid Kit
A first aid kit is one of the Ten Essentials you should always take on a hike, and it’s especially important on an overnight backpacking trip. Some of the stuff inside you’ll use fairly regularly and should replace often (moleskin for blisters, bandages, aspirin), while others are rarely used but may be critical in an emergency. Each person’s kit should vary depending on the medical conditions of the hikers in the party, the length and duration of the trip and the area you’ll be hiking into.To get more news about IFAK kit, you can visit rusuntacmed.com official website.
You can purchase prepackaged kits, like those from Adventure Medical Kits, but you may need to to supplement these kits with additional equipment, like any prescription medications you’re taking and medications for conditions specific to the hikers in your group (epinephrine pen for those allergic to bee stings, for example).
Organize and waterproof your kit with small resealable bags and plastic bottles. Label medications. You can also include other commonly used items in your first aid kit: lip balm, sunscreen, insect repellent, multi-use tool, and a small roll of duct tape (which is extremely handy for any and all repairs).
Some of the items above are not commonly found in standard first aid kits (including forceps, CPR masks, trauma scissors, and suction syringes) can be purchased online from Wilderness Medicine Training Center.
In addition to a fleshed out first aid kit, taking a Wilderness First Aid course is a great idea for folks who hike often. Wilderness Medicine Training Center and the National Outdoor Leadership School both offer two- and three-day Wilderness First Aid courses. Local groups like The Mountaineers and the Washington Alpine Club offer more advanced Mountaineering First Aid courses.
Protect life is about being prepared, never compromising wherever you are. Our first aid kits cover the essentials to keep you and your loved ones safe in a variety of situations. If you're traveling the world or just venturing outdoors for the day, your safety is vital. Take the first step to prepare! Click here to learn more about our products and how you can get started. The first aid kit is small, easy to carry, and has just the right size to fit anywhere. If for whatever reason, you are not satisfied with the product, we'll make it right, no questions asked. The kit contains 1 First aid guide, 1 CPR mask, one emergency blanket, and 1 triangular bandage. 1 medical scissor, 2 fabric Knuckle Adhesive Bandages. 2 metal Tweezers; 1 eyewash 15 ml; 2 antis n s crafted with 600D ripstop polyester, and strong zippers. The internal layout is organized by category so you can quickly find what you need in times of crisis. If emergency survival kit for outdoor camping, hiking, backpacking, travel.
MEDICAL KITS
We build IFAKs and tactical medical packs for almost every kind of operator, from the minimally trained outdoorsman to the veteran combat medic or paramedic and ranging in size from the smallest tactical IFAK to massive trunk-sized Recompression Dive kits. To get more news about hemostatic agents, you can visit rusuntacmed.com official website.
It is important that the contents of your IFAK are matched to your level of training and the type of injuries you are most likely to treat, so careful reading of contents lists is a must. Another consideration is the way it is packaged and contained—there is no point in paying for an elaborate thigh-rig if it is going to end up in a pack or vehicle. Please check out our extensive IFAK selection, as well as our EMS and First Responder offerings.
With so many options for battle belt IFAKs, it can be hard to sort through it all, but the Live the Creed Responder IFAK manages to provide the perfect package for virtually any loadout. Its non-traditional design and to-the-point equipment list covers virtually anything an operator (or mall ninja) could ever need.
Belt-mounted med kits must be compact, convenient affairs — something the Responder IFAK accomplishes with flair. In place of zippers, it features a single-buckle, sheath-and-sleeve design which allows fast access to life-saving equipment. This American-made kit includes all the MARCH essentials (minus a survival blanket), including an optional CAT tourniquet and holder mounted on the bottom. The backside features dual MOLLE-compatible mounting mounts with Maxpedition TacTie mounting clips that can double as belt loops, as well as a dedicated belt loop for mounting the pouch in a vertical position on up to 2.5-inch belts. The entire pouch consists of water-resistant, laser-cut laminate Cordura.
Unfortunately, the Responder is downright expensive, especially with the optional tourniquet and holder which are a package deal. Other drawbacks include the lack of a survival blanket, a potentially life-threatening omission for shock patients, and the fact that the tourniquet holster cannot be purchased and attached to the kit down the road. Users also reported that the buckle sometimes snags on the sheath during sleeve removal, although this is more a nuisance than an actual problem.
North American Rescue is a legend in the tactical medicine world, so it fits that the North American Rescue Eagle IFAK (Advanced Life Support) earned a spot on this list. While certainly comfortable on a battle belt, this emergency medical kit feels most at home mounted on your plate carrier.
The Eagle IFAK employs a clamshell-esque prominent loop handle and dual zippers down the front panel. Once secured to your vest with the dual rear-mounted MOLLE strips, the pouch can be ripped open with a single hand, and the Velcro-secured removable insert allows you to transfer your medical gear straight into your workspace. The insert features a large red pull tab for a quick, secure grip and secures the included medical equipment into place with a crisscrossing shock cord. This kit comes with nothing but the best, including a CAT tourniquet and vented HyFin chest seals, and the advanced life support (ALS) version that we recommend also includes Combat Gauze (instead of non-hemostatic S-gauze), a nasopharyngeal airway, and a decompression needle.
The Eagle IFAK’s biggest drawback is that it lacks a survival blanket, an odd omission considering the low cost, minimal space reduction, and life-saving potential of such an item. If you decide to purchase a second Eagle for your battle belt, you may be disappointed to find that it cannot be mounted horizontally. Lastly, North American Rescue requires a Medical Device Authorization to purchase the ALS version of this kit, an understandable yet annoying inconvenience.
The best first aid kits in 2022
Every home needs a dedicated first aid kit, even if just to organize the supplies scattered around in medicine cabinets, drawers and cupboards and make it much easier to grab them in a stressful situation. Whether you’re dealing with a fire, a weather emergency or just a skinned knee, an organized, complete kit can let you treat minor injuries quickly and effectively.To get more news about hemostasis, you can visit rusuntacmed.com official website.
To find the best first aid kits to keep in your home, car or with you while traveling, we tested 13 popular kits, ranging from pocket-size containers to backpacks full of gear, and consulted with experts at the Red Cross to best understand how to choose the right first aid kit for any situation.
An easy-to-use ring-binder-style design, high-quality products and all the essentials recommended by the Red Cross means you'll be sure to have everything you need and be able to find it when you need it.
Don’t let the rock-bottom price of this kit fool you — it provides a useful collection of name-brand items packed securely in an easy-to-transport case.
In addition to basic supplies for household use, this AMK kit is lightweight, it prioritizes organization and it includes several items specifically for treating common hiking, backpacking and camping issues.
With a heavy-duty case and a variety of high-quality items inside, this kit was a no-brainer as our top pick overall. Right out of the box we noticed how rugged and well made the case itself felt, complemented by metal grommets and sturdy zipper pulls. A wide handle also made it convenient for carrying around the house during our testing. We’re also big fans of the bright red color, which makes it easy to spot in a cluttered car trunk or backpack.
What really sets this kit apart from the other models we tested was its ring-binder-style design. Once unzipped, the contents are displayed in clear vinyl pockets that you simply flip through to find the item you want. This design also allows it to lay flat like a book while you use it, and the extra-large sleeve pouches at the front and back of the kit are large enough to store other emergency documents, such as allergy issues or specific medical issues of a family member. When it comes to clear organization and finding first aid items quickly and easily in an emergency, it really doesn’t get much easier than this.
Its focus on providing clear and concise first aid instructions and information was the other factor that separated this kit from the rest of the pack. In addition to a manual that includes straightforward instructions on dealing with common medical emergencies like choking, stroke, seizures and cardiac issues, the kit also includes several extra-large info sheets. These sheets are presented in large clear pockets on the left-hand side, with their corresponding first aid items on the right-hand side as you flip through.
This kit was also only one of three other kits we tested that provided all of the essential items recommended by our Red Cross expert, Jeffrey L. Pellegrino. It also included two pairs of non-latex exam gloves, which, as the Red Cross explains, will allow you to change gloves if needed, or allow a second responder to help out at the same time. We were also impressed with the overall quality of the 115 pieces inside. The 1-inch-by-10-yard tape roll was a particular standout, and along with the bandages and dressings, held up really well during hands-on testing. Although the scissors were relatively small compared to the EMT-style shears found in other kits, they had no trouble cutting through the tape or trimming gauze.
The durability, usability and variety provided by this kit make it just as useful in your cupboard as a go-to home first aid kit as it would in the trunk of your car or backpack on a camping trip.