External Ventricular Drain
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External Ventricular Drain
An external ventricular drain (EVD), also known as a ventriculostomy or extraventricular drain, is a device used in neurosurgery to treat hydrocephalus and relieve elevated intracranial pressure when the normal flow of cerebrospinal fluid (CSF) inside the brain is obstructed. An EVD is a flexible plastic catheter placed by a neurosurgeon or neurointensivist and managed by intensive care unit (ICU) physicians and nurses. The purpose of external ventricular drainage is to divert fluid from the ventricles of the brain and allow for monitoring of intracranial pressure. An EVD must be placed in a center with full neurosurgical capabilities, because immediate neurosurgical intervention can be needed if a complication of EVD placement, such as bleeding, is encountered. EVDs are a short-term solution to hydrocephalus, and if the underlying hydrocephalus does not eventually resolve, it may be necessary to convert the EVD to a cerebral shunt, which is a fully internalized, long-term treat ...
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Ventriculostomy
Ventriculostomy is a neurosurgical procedure that involves creating a hole (stoma) within a cerebral ventricle for drainage. It is most commonly performed on those with hydrocephalus. It is done by surgically penetrating the skull, dura mater, and brain such that the ventricular system ventricle of the brain is accessed. When catheter drainage is temporary, it is commonly referred to as an external ventricular drain (EVD). When catheter drainage is permanent, it is usually referred to as a shunt. There are many catheter-based ventricular shunts that are named for where they terminate, for example, a ventriculoperitoneal shunt terminates in the peritoneal cavity, a ventriculoatrial shunt terminates within the atrium of the heart, etc. The most common entry point on the skull is called Kocher's point, which is measured 11 cm posterior to the nasion and 3 cm lateral to midline. EVD ventriculostomy (catheter within the lateral ventricle with tip at the foramen of Monro) ...
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Intracerebral Hemorrhage
Intracerebral hemorrhage (ICH), also known as hemorrhagic stroke, is a sudden bleeding into Intraparenchymal hemorrhage, the tissues of the brain (i.e. the parenchyma), into its Intraventricular hemorrhage, ventricles, or into both. An ICH is a type of bleeding within the skull and one kind of stroke (ischemic stroke being the other). Symptoms can vary dramatically depending on the severity (how much blood), acuity (over what timeframe), and location (anatomically) but can include headache, Hemiparesis, one-sided weakness, numbness, tingling, or Hemiplegia, paralysis, speech problems, vision or hearing problems, memory loss, attention problems, coordination problems, balance problems, dizziness or Presyncope, lightheadedness or vertigo, nausea/vomiting, seizures, decreased level of consciousness or Unconsciousness, total loss of consciousness, neck stiffness, and fever. Hemorrhagic stroke may occur on the background of alterations to the blood vessels in the brain, such as cer ...
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Reticular Activating System
The reticular formation is a set of interconnected nuclei in the brainstem that spans from the lower end of the medulla oblongata to the upper end of the midbrain. The neurons of the reticular formation make up a complex set of neural networks in the core of the brainstem. The reticular formation is made up of a diffuse net-like formation of reticular nuclei which is not well-defined. It may be seen as being made up of all the interspersed cells in the brainstem between the more compact and named structures. The reticular formation is functionally divided into the ascending reticular activating system (ARAS), ascending pathways to the cerebral cortex, and the descending reticular system, descending pathways ( reticulospinal tracts) to the spinal cord. Due to its extent along the brainstem it may be divided into different areas such as the midbrain reticular formation, the central mesencephalic reticular formation, the pontine reticular formation, the paramedian pontine reticul ...
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Infection Control
Infection prevention and control (IPC) is the discipline concerned with preventing healthcare-associated infections; a practical rather than academic sub-discipline of epidemiology. In Northern Europe, infection prevention and control is expanded from healthcare into a component in public health, known as "infection protection" (''smittevern, smittskydd, Infektionsschutz'' in the local languages). It is an essential part of the infrastructure of health care. Infection control and hospital epidemiology are akin to public health practice, practiced within the confines of a particular health-care delivery system rather than directed at society as a whole. Infection control addresses factors related to the spread of infections within the healthcare setting, whether among patients, from patients to staff, from staff to patients, or among staff. This includes preventive measures such as hand washing, cleaning, disinfecting, sterilizing, and vaccinating. Other aspects include survei ...
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Ventriculitis
Ventriculitis, also known as ependymitis, ventricular empyema, pyocephalus, and pyogenic ventriculitis, is the inflammation of the ventricles in the brain. The ventricles are responsible for containing and circulating cerebrospinal fluid throughout the brain. Ventriculitis is caused by infection of the ventricles, leading to swelling and inflammation. This is especially prevalent in patients with external ventricular drains and intraventricular stents. Ventriculitis can cause a wide variety of short-term symptoms and long-term side effects ranging from headaches and dizziness to unconsciousness and death if not treated early. It is treated with some appropriate combination of antibiotics in order to rid the patient of the underlying infection. Much of the current research involving ventriculitis focuses specifically around defining the disease and what causes it. This will allow for much more advancement in the subject. There is also a lot of attention being paid to possible tre ...
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Surgical Staple
Surgical staples are specialized Staple (fastener), staples used in surgery in place of surgical suture, sutures to close skin wounds or to resection (surgery), resect and/or anastomosis, connect parts of an Organ (biology), organ (e.g. bowels, stomach or lungs). The use of staples over sutures reduces the local inflammatory response, width of the wound, and time it takes to close a defect. A more recent development, from the 1990s, uses clips instead of staples for some applications; this does not require the staple to penetrate. History The technique was pioneered by "father of surgical stapling", Hungarian surgeon Hümér Hültl. Hultl's prototype stapler of 1908 weighed , and required two hours to assemble and load. The technology was refined in the 1950s in the Soviet Union, allowing for the first commercially produced re-usable stapling devices for creation of bowel and Surgical anastomosis, anastomoses. Mark M. Ravitch brought a sample of stapling device after attendin ...
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Surgical Suture
A surgical suture, also known as a stitch or stitches, is a medical device used to hold Tissue (biology), body tissues together and approximate wound edges after an injury or surgery. Application generally involves using a Sewing needle, needle with an attached length of thread (yarn), thread. There are numerous types of suture which differ by needle shape and size as well as thread material and characteristics. Selection of surgical suture should be determined by the characteristics and location of the wound or the specific body tissues being approximated. In selecting the needle, thread, and suturing technique to use for a specific patient, a medical care provider must consider the tensile strength of the specific suture thread needed to efficiently hold the tissues together depending on the mechanical and shear forces acting on the wound as well as the thickness of the tissue being approximated. One must also consider the elasticity of the thread and ability to adapt to differe ...
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Coagulopathy
Coagulopathy (also called a bleeding disorder) is a condition in which the blood's ability to coagulate (form clots) is impaired. This condition can cause a tendency toward prolonged or excessive bleeding ( bleeding diathesis), which may occur spontaneously or following an injury or medical and dental procedures. Coagulopathies are sometimes erroneously referred to as "clotting disorders", but a clotting disorder is the opposite, defined as a predisposition to excessive clot formation (thrombus), also known as a hypercoagulable state or thrombophilia. Signs and symptoms Coagulopathy may cause uncontrolled internal or external bleeding. Left untreated, uncontrolled bleeding may cause damage to joints, muscles, or internal organs and may be life-threatening. People should seek immediate medical care for serious symptoms, including heavy external bleeding, blood in the urine or stool, double vision, severe head or neck pain, repeated vomiting, difficulty walking, convulsions, or ...
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Mean Arterial Pressure
In medicine, the mean arterial pressure (MAP) is an average calculated blood pressure in an individual during a single cardiac cycle. Although methods of estimating MAP vary, a common calculation is to take one-third of the pulse pressure (the difference between the systolic pressure, systolic and diastolic pressures), and add that amount to the diastolic pressure. A normal MAP is about 90 mmHg. MAP is altered by cardiac output and systemic vascular resistance. It is used clinically to estimate the risk of cardiovascular diseases, where a MAP of 90 mmHg or less is low risk, and a MAP of greater than 96 mmHg represents "stage one hypertension" with increased risk. Testing Mean arterial pressure can be measured directly or estimated from systolic and diastolic blood pressure by using a formula. In the direct approach, mean arterial pressure can be calculated exactly using an Arterial line, arterial catheter with a transducer; this device inserted into the bloodstream measur ...
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Cerebral Perfusion Pressure
Cerebral perfusion pressure, or CPP, is the net pressure gradient causing cerebral blood flow to the brain (brain perfusion). It must be maintained within narrow limits because too little pressure could cause brain tissue to become ischemic (having inadequate blood flow), and too much could raise intracranial pressure (ICP). Definitions The cranium encloses a fixed-volume space that holds three components: blood, cerebrospinal fluid (CSF), and very soft tissue (the brain). While both the blood and CSF have poor compression capacity, the brain is easily compressible. Every increase of ICP can cause a change in tissue perfusion and an increase in stroke events. From resistance CPP can be defined as the pressure gradient causing cerebral blood flow (CBF) such that : CBF = CPP/CVR where: :CVR is cerebrovascular resistance By intracranial pressure An alternative definition of CPP is: : CPP=MAP-ICP where: :MAP is mean arterial pressure :ICP is intracranial pressure :JVP is jugu ...
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Hydrostatic Pressure
Hydrostatics is the branch of fluid mechanics that studies fluids at hydrostatic equilibrium and "the pressure in a fluid or exerted by a fluid on an immersed body". The word "hydrostatics" is sometimes used to refer specifically to water and other liquids, but more often it includes both gases and liquids, whether Compressible flow, compressible or Incompressible flow, incompressible. It encompasses the study of the conditions under which fluids are at rest in Mechanical equilibrium, stable equilibrium. It is opposed to ''fluid dynamics'', the study of fluids in motion. Hydrostatics is fundamental to ''hydraulics'', the engineering of equipment for storing, transporting and using fluids. It is also relevant to geophysics and astrophysics (for example, in understanding plate tectonics and the anomalies of the Gravity of Earth, Earth's gravitational field), to meteorology, to medicine (in the context of blood pressure), and many other fields. Hydrostatics offers physical expl ...
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Ear Canal
The ear canal (external acoustic meatus, external auditory meatus, EAM) is a pathway running from the outer ear to the middle ear. The adult human ear canal extends from the auricle to the eardrum and is about in length and in diameter. Structure The human ear canal is divided into two parts. The elastic cartilage part forms the outer third of the canal; its anterior and lower wall are cartilaginous, whereas its superior and back wall are fibrous. The cartilage is the continuation of the cartilage framework of auricle. The cartilaginous portion of the ear canal contains small hairs and specialized sweat glands, called apocrine glands, which produce cerumen ( ear wax). The bony part forms the inner two thirds. The bony part is much shorter in children and is only a ring (''annulus tympanicus'') in the newborn. The layer of epithelium encompassing the bony portion of the ear canal is much thinner and therefore, more sensitive in comparison to the cartilaginous portion. Size ...
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