Wound Closure by Surigical Staples

Staples are formed from high-quality stainless steel and are available in regular and wide sizes.

Staples are composed of:

(1) a cross-member that lays on the surface of the skin perpendicular to the wound,
(2) legs that are vertically placed in the skin
(3) tips that secure the staple parallel to the cross-member.

Staples are relatively easy to place and may shorten the closure time by 70-80%.

The primary utility of staples is in the closure of wounds under high tension on the trunk, extremities, and scalp.ON the other hand they are not used in delicate tissues or wounds in finely contoured areas, over bony prominences, or in highly mobile areas.

Advantages of staples include:

* rapid speed of closure
* a decreased risk of infection
* improved wound eversion
* minimal tissue reactivity.

Disadvantages include

* the need for a second operator to evert and reapproximate skin edges during staple placement
* greater risk of crosshatch marking
* less precise wound approximation.
* The cost is usually more than that of suture material.

Surgical staples used on a skin incision in groin after inguinal hernia operation.

The Pathway Balloon Expandable PCNL Sheath

The Next Generation for PCNL "Percutaneous Nephrolithotomy Sheath" Procedures. A One-Step Percutaneous Nephrolithotomy Sheath.

SOMI ( Sterno Occipital Mandibular Immobilizer )

The sterno-occipital-mandibular immobilizer (SOMI) cervical orthosis is a rigid cervico thoracic orthosis used for supporting the ervical spine . SOMI does not provide complete immobilization though. It is somewhere between a Philadelphia collar and a halo brace.

Somi Brace ( Sterno Occipital Mandibular Immobilizer ) designed to apply forces under the chin and occiput to restrict flexion and extension as well as rotation of the head and cervical spine.

Structurally, it has a chest plate that goes up to the notch where the collarbones meet in the front and metal, aluminum, or plastic bars that curve over the shoulder.

Straps from the bars go over the shoulder and cross to the opposite side of the anterior plate to hold it in place.

Cardiac Pacemaker

It is represents External Energy Sources Used To Stimulate The Heart Primarily In Patients With Symptomatic Heart Blocks And Bradyarrhythmias.

 Indication :

* Selection Of The Appropriate Pacemaker And Pacing Mode Depends On The Clinical Condition And The Type Of Bradyarrhythmia Being Treated
* Temporary Pacing :

• For Symptomatic Bradicardia Due To Temporary Condition, Or As A Bridge To Permanent Pacer Placement

* Permanent Pacing : 

• Symptomatic Bradycardia Due To : SA Nodal Dysfunction, Irreversible 2nd Or 3rd Degree AV Block
• Recurrent Syncope Due To Carotid Sinus Hypersensitivity

* Physiologic Pacemakers (Rate Modulating) Are Essential When :

• Chronotropic Incompetence Is Present
• An Increase In Heart Rate Is Required To Enchance Physiologic Performance

Screening for Diabetic Retinopathy by new Fundus Camera

Surgical drains & it`s types

At the beginning we use drains to:
1- Evacuate establish collections of pus, blood or other fluids (e.g. lymph)
2- Drain potential collections
They are often made from inert silastic material and induce minimal tissue reaction
.Red rubber drains induce an intense tissue reaction allowing a tract to form

# Arguments for their use include:
* Drainage of fluid removes potential sources of infection
* Drains guard against further fluid collections
* May allow the early detection of anastomotic leaks or haemorrhage
* Leave a tract for potential collections to drain following removal



# Arguments against their use include:
* Presence of a drain increases the risk of infection
* Damage may be caused by mechanical pressure or suction
* Drains may induce an anastomotic leak
* Most drains abdominal drains infective within 24 hours

Types :- * Drains can be:

• Open or closed


• Active or passive

Open drains


* Include corrugated rubber or plastic sheets
* Drain fluid collects in gauze pad or stoma bag
* They increase the risk of infection

Closed drains

* Consist of tubes draining into a bag or bottle
* They include chest and abdominal drains
* The risk of infection is reduced

Active drains

* Active drains are maintained under suction
* They can be under low or high pressure

Passive drains

* Passive drains have no suction
* Function by the differential pressure between body cavities and the exterior

Foley Catheter

A Foley catheter is a thin, sterile tube inserted into the bladder to drain urine. Because it can be left in place in the bladder for a period of time, it is also called an indwelling catheter. It is held in place with a balloon at the end, which is filled with sterile water to hold it in place. The urine drains into a bag and can then be taken from an outlet device to be drained. Laboratory tests can be conducted on your urine to look for infection, blood, muscle breakdown, crystals, electrolytes, and kidney function. The procedure to insert a catheter is called catheterization.

A Foley catheter is used with many disorders, procedures, or problems such as these:

1.Retention of urine leading to urinary hesitancy, straining to urinate, decrease in size and force of the urinary stream, interruption of urinary stream, and sensation of incomplete emptying
2.Obstruction of the urethra by an anatomical condition that makes it difficult for you to urinate: prostate hypertrophy, prostate cancer, or narrowing of the urethra
3.Urine output monitoring in a critically ill or injured person
4.Collection of a sterile urine specimen for diagnostic purposes
5.Nerve-related bladder dysfunction, such as after spinal trauma (A catheter can be inserted regularly to assist with urination.)
6.Imaging study of the lower urinary tract
7.After surgery

Risks:

-The balloon can break while the catheter is being inserted. In this case, the doctor will remove all the balloon fragments.
-The balloon does not inflate after it is in place. Usually the doctor will check the balloon inflation before inserting the catheter into the urethra. If the balloon still does not inflate after its placement into the bladder, the doctor will then insert another Foley catheter.
-Urine stops flowing into the bag. The doctor will check for correct positioning of the catheter and bag or for obstruction of urine flow within the catheter tube.
-Urine flow is blocked. The doctor will have to change the bag or the Foley catheter or both.
-Patient urethra begins to bleed. The doctor will have to monitor the bleeding.
The Foley catheter may introduce an infection into the bladder. The risk of infection in the urine increases with the number of days the catheter is in place.
-If the balloon is opened before the Foley catheter is completely inserted into the bladder, bleeding, damage and even rupture of the urethra can occur. In some individuals, long-term permanent scarring and strictures of the urethra could occur.

Too see Procedure......

HERE

Asian Ear Cleaning Tools

Ear cleaning is a very intimate process and feels extremely pleasant and stimulating when conducted by a trusted person. It has been traditionally performed in Asian countries for ages. People who experienced the sensation of having their ears cleaning during a trip to Japan, Thailand or Vietnam describe it as "Amazing", "Incredibly soothing" and "extremely relaxing". It has also been said that the procedure is like "intercourse for your ear".

As a sense organ the ear has a lot of nerve endings that are connected to other parts of our body, particularly internal organs. The stimulation to touch is therefore exciting and relaxing. Most people fall asleep within minutes due to the comfort this provides.

Extraglottis Devices

Ear Wash System by Welch Allyn

Designed with safety in mind, the Welch Allyn Ear Wash System includes several built-in features that reduce side effects associated with other ear irrigation devices - including vertigo, nausea, deeper cerumen impaction, perforated ear drums, and other tympanic membrane damage.


What makes the Welch Allyn Ear Wash System truly revolutionary is its built-in Hydrovac Action. This proprietary technology features simultaneous irrigation and suction capabilities, which means all discharge is directed away from you and the patient. And since you can easily control and monitor suction, water temperature, and pressure levels, the Ear Wash System is ideal for patients of all ages. What's more, it comes with over ten feet of clear, heavy-duty plastic tubing that lets you position the patient almost anywhere in the room, as well as visualize the process.

Rectum Exam by Proctoscope

Tonometry

Pregnant Robot Trains Students

Medical students at Johns Hopkins University are getting a real-life birthing experience when a robot goes into labor.

ProGuide™ Chronic Dialysis Catheter Insertion

The ProGuide™ Chronic Dialysis Catheter features a unique apposition deflection feature (the "bump") designed to minimize recirculation and optimize flow rates even when positioned against the vessel wall. ProGuide™ is the first in a series of innovative dialysis products designed for the needs of interventionalists.

Urinary catheters :Do's and don'ts

It is a form of drain which Can be inserted transurethrally or suprapubically

*Commonly used to:

1- Alleviate or prevent urinary retention

2- Monitor urine output



* Catheters vary by:

o The material from which they are made (latex, plastic, silastic, teflon-coated)

o The length of the catheter (38 cm 'male' or '22 cm 'female')

o The diameter of the catheter (10 Fr to 24 Fr)

o The number of channels (two or three)

o The size of the balloon ( 5ml to 30 ml)

o The shape of the tip

* Special catheters exist such as:

• Gibbon catheters
• Nelaton catheters
• Tiemann catheters
• Malecot catheters

Complications :

* Paraphimosis

* Blockage

* By-passing

* Infection

* Failure of balloon to deflate

* Urethral strictures



Do's and don'ts of urinary catheters



* Choose an appropriate sized catheter

* Insert using an aseptic technique

* Never insert using force

* Do not inflate the balloon until urine has been seen coming from the catheter

* Record the residual volume

* Do not use a catheter introducer unless you have been trained in its use

* If difficulty is encountered inserting a urinary catheter consider a suprapubic

* Remove at the earliest possibility

Contents of foley catheter kits

Commercial kits are available which contain all of the equipment needed to place a urethral catheter. These kits usually contain a standard-tip 14-16 Fr catheter, a urine collection bag, and the rest of the required supplies. Viscous lidocaine, which should be used when placing a catheter in a male patient (see Procedure section) is not included in the standard kit and must be obtained separately.

Foley's catheter insertion in male and female

TYPES OF FOLEY CATHETERS

Transurethral catheters (Foley catheters) have one-way, two-way or three-way variations. The one-way catheter is a simple tube used to remove urine without securing the tube. This is used when someone is "straight catheterized." The two-way tubing has an outlet for urine and a conduit for water inflation of the catheter's balloon. This is the most commonly used catheter. The three-way tubing has an outlet for urine, an inlet for water inflation of the balloon, and an inlet for normal saline used for irrigating the urinary system most commonly for gross hematuria. There also exist whistle-tipped and multi-eyed variations. These tubes have larger and more draining holes, respectively, and are useful when blood clots are present. Most catheters are made of silicon, which is smoother than latex. Silicon catheters should be used in patients with an allergy to latex.