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Biomedical subjects

Raymond G Hart

Publications and source records attributed to Raymond G Hart.

8 recordsLinked to original sources
PubMed2006

Prevention of high-pressure injection injuries to the hand.

OBJECTIVES: To identify populations at high risk for, and the usual mechanisms of injury in, high-pressure injection injuries to the hand. METHODS: A case note review of a historical cohort of 76 patients, presenting with high-pressure injections injuries to the hand over a 12-year period, collected information including sex, age, hand dominance, and occupation of the patient and mechanism of injury, when documented. RESULTS: Eighty-two percent of these injuries were work-related, affecting mainly manual workers (84%), including 13 painters, 10 mechanics, 8 farmers, and 3 water blasters. The mechanism of injury, recorded in 63%, was most commonly a ruptured hose or inadvertent gun discharge during cleaning or use. CONCLUSIONS: Preventative measures could include a targeted safety program for equipment users, engineering improvements in gun and hose design, economic incentives, and workplace legislation.

Adult↗
PubMed2005

Transthecal digital block: an underutilized technique in the ED.

The transthecal digital block is a simple, safe, and effective anesthesia technique that can be used in many digital injuries. It is contraindicated only in cases of infection. The purposes of this article are to (1) discuss the indications for the transthecal digital block, (2) describe the technique, and (3) review the literature. The transthecal technique is used on appropriate patients almost to the exclusion of more traditional digital blocks by many hand surgeons. The advantages of this method are that it requires only a single injection, has a rapid onset of action, and requires only a small amount of anesthetic. It also has virtually no risk of direct mechanical trauma to the neurovascular bundles. This technique has been shown to be exceptionally effective. We encourage emergency physicians to use the transthecal technique when indicated.

Anesthesia↗
PubMed2005

The Kleinert modified dorsal finger splint for mallet finger fracture.

Injuries to the hand and digits are commonly seen in the emergency department. Lacerations, contusions, puncture wounds, and fractures comprise the bulk of these injuries. A fracture to the dorsum of the distal phalanx can result in a mallet finger deformity. These fractures must be accurately diagnosed with the proper initial treatment begun. There is some disagreement over the best treatment approach and multiple different splints have been described in the literature. Conservative treatment with a finger splint is most commonly effective. We recommend a modified dorsal finger splint for these injuries. We describe a splint to properly treat the fracture, prevent complications, maximize patient comfort during rehabilitation, and prevent mallet finger deformity.

Emergency Medicine↗
PubMed2005

Slipper cast management of emergency foot problems.

Foot conditions are frequently seen in the emergency department. In many cases, although weight bearing is painful, it is not precluded, per se. When a soft dressing does not provide sufficient support, a below knee walking cast may be applied. We present an alternative dressing that may be of benefit in selected foot injuries. The dressing is fashioned with cast padding, foam sheeting and plaster. It is designed and molded to fit like a slipper. The plaster slipper has distinct advantages in that it is comfortable, lighter for the patient, and avoids the problem of ankle stiffness. We believe that this option is underused in the emergency setting.

Ankle↗
PubMed2005

Fiberglass cast application.

Plaster of Paris has been largely superceded for casting in orthopedic departments by synthetic cast materials. Despite its weight, its relative brittleness, its unpopularity with patients, and its messiness in application, plaster of Paris remains the mainstay of casting in the emergency department. This is due to a combination of economic reasons, the belief that synthetic casts leave less room for swelling and its relative ease of application compared to synthetic materials. We present a technique for synthetic cast application that avoids the problems of the rapidly setting cast and therefore allows the time for less experienced hands to produce a well-fitting cast or splint. We believe that this option, which allows the patient to have a lighter synthetic cast, rather than the traditional plaster of Paris cast, will be welcomed by both the patient and physician.

Casts, Surgical↗
PubMed2005

A modified thumb spica splint for thumb injuries in the ED.

There are a significant number of hand and upper extremity injuries treated in US emergency departments (EDs) each year. Many of these involve the thumb and wrist. These injuries encompass the range from fractures, strains, and sprains to more specific injuries such as gamekeeper thumb and de Quervain tenosynovitis. These injuries often require diagnosis, splinting, and referral to a hand or orthopedic surgeon. The splint described in this article is presently being used for patients with de Quervain tenosynovitis, but it may have more widespread application in emergency medicine. It is a safe and simple splint that is underused in EDs for splinting thumb injuries.

Emergency Medicine↗
PubMed2004

Preventing tourniquet effect when dressing finger wounds in children.

Hand and finger injuries are common injuries in children seen in emergency departments. Many of these are soft tissue injuries, which are often caused by household items, such as doors and exercise equipment. Once these injuries are repaired, usually they are covered with a simple dressing using a material such as Coban (3M, Minneapolis, MN). This dressing often is applied by winding it circumferentially around the digit. However, with very little manipulation, this dressing can be lifted and rolled up the digit in a distal direction, creating a tourniquet effect, which can cause hypoxia and tissue necrosis. To prevent the tourniquet effect, the dressing must include the hand and wrist.

Bandages↗