Persistent pain after mastectomy

Persistent pain after mastectomy - Part I

4 types of chronic neuropathic pain following breast cancer surgery due to surgical trauma:

Jung BF et al. - Neuropathic pain following breast cancer surgery: proposed classification and research update. Pain 2003;104:1-13

1-Intercostobrachial neuralgia ++: post mastectomy pain syndrome consists of pain and sensory changes localized to the distribustion of the ICBN - the axilla, medial upper arm, and/or the anterior chest wall on the ipsilateral side of the surgery. Fabro et al. Post-mastectomy pain syndrome: Incidence and risks. The Breast 2012, 321-325 .

2-Pain secondary to the presence of a neuroma: Neuroma is formed from masses of tangled axons formed at the end of severed peripheral nerves trapped in scar tissue.

3-Phantom breast pain: sensory experience of a removed breast that is still present and is painful

4-Other nerve injury pain: may result from damage or traction to the medial and lateral pectoral, long thoracic (pain at rest in the shoulder - winging scapula), or thoracodorsal nerves.

Comments

Falling from Height...The Prognostic factors

Falls from Height is Knwon to cause major morbidities and mortalities. There are several prognostic factors for survival that have been identified: Height Age Type of surface Body part that touches the ground first Two other factors are important, but do not have a significant effect on mortality: Circumstances of the fall (suicide, accident, escape) Initial impact with an object before impacting the ground Height . Overall, about half of victims die at the scene, and a total of 70% die before they reach the hospital . The median height leading to death is about 49 feet, or about 4 to 5 storeys. 100% of victims die after falling 85 feet, or about 8 storeys. Age . Mortality increases with age due to pre-existing medical conditions and decreased physiologic reserve. Type of surface . The type of surface struck (i.e. grass, water, construction debris) can also have an effect on secondary injuries and survival. Mortality after striking a hard surface is nearly doubl...

power injectable peripherally inserted central catheters

Clinical experience with power injectable peripherally inserted central catheters in intensive care patients Introduction In intensive care units (ICU), peripherally inserted central catheters (PICC) may be an alternative option to standard central venous catheters, particularly in patients with coagulation disorders or at high risk for infection. Some limits of PICCs (such as low flow rates) may be overcome by the use of power-injectable catheters . Method We have retrospectively reviewed all the power injectable PICCs inserted in adult and pediatric patients in the ICU during a 12-month period, focusing on the rate of complications at insertion and during maintenance. Results We have collected 89 power injectable PICCs (in adults and in children), both multiple and single lumen. All insertions were successful. There were no major complications at insertion and no episodes of catheter-related blood stream infection. Non-infective complications ...

Bleeding...when the HR and BP mislead you

We always rely on the classical clinical picture of hypotension and tachycardia to make the diagnosis of hypovolemia .....but here is the two examples when the classical way may mislead you .... Beta-blockers or calcium channel blockers may blunt the usual heart rate response to severe bleeding. Among patients with chronic hypertension, a "normal" blood pressure may actually suggest relative hypotension.

sedationstation

Search This Blog