S Afr J Surg
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Advancements in intensive care therapy have progressed rapidly over the last two decades. Associated with this have been scientifically unsubstantiated sedation and analgesia practices in the intensive care unit. ⋯ In an analysis of the literature, we have attempted to present a practical approach to sedation and analgesia practices in the critically ill patient. The aim is to present a framework upon which medical personnel managing critically ill patients can develop a strategy for their own circumstances.
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There are few studies which address the burnt male patient who has been intentionally assaulted by his partner. Thirty such patients were admitted to the Somerset Hospital Burns Unit between January 1993 and May 1995. The average age was 37 years and the mean total burn surface area was 19.6% (range 2-55%). ⋯ Three patients died: 1 of respiratory failure and 1 of septicaemia, while 1 committed suicide. The burnt and battered male patient is a real clinical entity which is becoming more common. Treatment should investigate psychosocial factors in addition to ensuring healing of the burn wound.
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Cardiac rupture as a result of blunt trauma is not commonly encountered. Seven patients with this injury have been treated at Groote Schuur Hospital over the past 14 years. All presented with cardiovascular collapse and 4 developed signs of cardiac tamponade. ⋯ Five patients had right atrial ruptures and 2 right ventricular ruptures. One patient with right ventricular rupture died in the operating room, while another patient with multiple right atrial ruptures died from multiple organ failure after 11 days. We also briefly review the history, mechanisms and pathology.
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Randomized Controlled Trial Clinical Trial
Transcutaneous electrical nerve stimulation in the treatment of myofascial pain dysfunction.
The effect of transcutaneous electrical nerve stimulation (TENS) plus conservative therapy (ibuprofen, bite plate, self-physiotherapy) on myofascial pain dysfunction (MPD) was determined. A single-blind trial as done in 10 patients with MPD with subthreshold TENS (frequency 35 Hz, pulse width 100 milliseconds, modulation 50%) compared with sham TENS at 8 visits over 14 weeks. ⋯ A highly significant effect was seen for time (F = 4.80, P = 0.0003) but not for TENS. Subthreshold TENS did not increase the symptom relief produced by conservative treatment with the protocol used.