Tension Pneumothorax

Tension Pneumothorax is a life threatening condition in which air leaks outside of the lung and the air is trapped between the pleura and the lung.

Air leaks outside of the lung into the pleural cavity. The air is trapped between the pleura and the lung. The air in the pleural space cannot exit! This prevents expansion of the lung and oxygenation. This condition leads to hypoxia and cardiopulmonary collapse. The patient will have acute unilateral chest pain, dysnia, respiratory distress, tachypnea and tachycardia. The patient will also have unilateral decreased or absent breath sounds. As air pushes against the lung, it deviates the trachea to the other side.

Treatment

Treatment will include needle decompression. Insert the needle at the 2^nd intercostal space, mid clavicular line, followed by the insertion of a chest tube.

Bone Healing – A Basic Introduction

Dr. Nabil Ebraheim
Image: uthealth.utoledo.edu/

As the chair and a professor of the Department of Orthopaedic Surgery at the Medical University of Ohio, Dr. Nabil Ebraheim teaches the diagnosis and operative treatment of diseases and injuries of the musculoskeletal system. Also the director of the university’s orthopaedic trauma fellowship and the author of many peer-reviewed papers, Dr. Nabil Ebraheim pursues a focus on bone healing.

Bone healing is a multiphase process. It begins with inflammation, which occurs when blood flows from the fracture into the surrounding area. As this happens, the tissue swells and the blood forms clots, which create stability at the site. This clotted blood also forms the initial scaffolding for the growth of new bone.

Bone production occurs first with the production of a soft callus. Specialized cells called chondroblasts create this initial repair structure, the building of which can take up to three weeks. Once the soft callus is fully formed, the body activates osteoblast cells to create new bone cells, which form a harder callus.

The final and longest phase of healing is known as bone remodeling. During this phase, which can take a period of three to nine years to complete, the new bone becomes harder and more structurally sound. At the same time, osteoclast cells dissolve the excess bone tissue at the outside of the hard callus, and the bone slowly returns to its original shape.

Marjolin’s Ulcer

Marjolin’s ulcer is a malignant tumor that usually develops into squamous cell sarcoma inside of an osteomyelitis sinus tract.

Fungating soft tissue mass that increases in size and has a foul smell in addition to x-rays that show chronic osteomyelitis that may indicate malignant transformation. It usually takes a long time to develop (about 20 – 30 years).

This tumor usually occurs in the lower extremity and can occur in association with burns, decubitus ulcer and venous ulcer. The skin lesion appears more aggressive with more metastasis (it also can spread to the lymph nodes). There is more recurrence than other types of skin cancers and it is associated with a high mortality rate.

The treatment is usually an amputation. Preservation of the extremity function through a wide resection may not be possible.

Difference between Marjolin’s ulcer and Mandura foot:

Majorlin’s ulcer is a malignant slow growing squamous cell carcinoma that usually develops inside of an osteomyelitis sinus tract. Mandura foot is localized swelling with multiple discharging sinuses (usually fungus). The discharge is grain filled or granular.

Creating Sustainable Balance Among Your Team

Imagine your organization resembles a sailing boat. You will see a lot of good days, but some bad days. On the good days, there is calm weather, sunshine, smooth sailing, and peaceful enjoyment of nature. On the bad days, there is cloudy weather, rough waters, and sometime you will face a hurricane.

On this boat there are three types of people:

1. Paddler (30% of people): Engaged – Meant to keep the boat moving forward, working above and beyond with a sense of purpose. These are the BEST assets to your organization! They are creative and motivated to help organizations succeed. And they are proud of the contribution their organization makes to the community.
2. Passenger (50% of people): Disengaged – Neutral, they think situations don’t affect them. They are not involved at all. There are here doing their job or doing the bare minimum.
3. Boat Sinker (20% of people): Actively Disengaged – They are the biggest threats to the organization. They often use negativity and pointing fingers to aid in tearing an organization apart.

Leaders must confront the people who are trying to sink the boat. Either they must paddle or get off the boat.

Which type are you? Are you a paddler, a passenger, or are you trying to sink the boat?