The Immobilized Patient: Functional Pathology and Management by Franz U. Steinberg

By Franz U. Steinberg

Teach us to dwell that we may well dread pointless time in mattress Get humans up and we may well store Our sufferers from an early grave. A such a lot revealing paraphrase by means of Asher* of a verse through Bishop Thomas Ken greater than properly summarizes the plight of the immobilized sufferer, who usually lies dormant and de­ pressed for years on finish. during this quantity, Dr. Steinberg has provided the reader a special chance to percentage his decades of expertise in taking care of the immobilized sufferer. His cautious try and discover the pathophysiologic results of immobilization on a couple of organ structures, mixed with a bunch of sensible facets with reference to sufferer care, is exclusive and fresh. this article should still command the re­ spect of any surgeon confronted with the vicissitudes and frus­ trations of taking good care of the immobilized. the ultimate bankruptcy de­ tailing "The mental features of Immobilization," through Hammer and Kenan, deals the reader massive perception into the necessities and price of occupational and actual treatment. it may end up most beneficial to physicians besides "Asher, R. A. ]. hazards of going to mattress. Br. Med. J. 2:907, 1947. v vi FOREWORD as social staff, paramedical team of workers, and the numerous actual therapists who come into day-by-day touch with the nonambulatory sufferer. L. V. Avioli St. Louis Preface it can be a paradox that the significance of incapacity and immobilization has been greater through the very growth of clinical science.

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Sunden's findings, therefore, suggest that Geiser and Trueta's period of hypervascularity is associated with a decreased sluggish blood flow. The blood remains stagnant in overfilled vessels. This concept is further supported by the experiments of Hardt. to Ten days after immobilization, he found a decrease of the P co. and an increase of the pH and po. in the blood of the nutrient vein of bone suggesting an increase of bone blood flow. After 15 days, the condition was reversed. Venous pH and po.

The use of low-dose heparin and of drugs which reduce platelet aggregation, such as aspirin and dipyridamole, carries fewer risks than anticoagulation, but their value in the prevention of venous thrombosis has not been well established. 30 Physical measures that accelerate the blood flow in the veins reduce the incidence of clot formation. As pointed out before, prolonged bed rest does not lower the velocity of blood flow through lower extremity veins. On the other hand it stands to reason that blood that flows more rapidly is less likely to clot, regardless of other circumstances.

Therefore, patients should be taught how to exercise their lower extremity muscles. The use of elastic stockings or bandages has become routine in many institutions. Proper application is important. Husni et al. have shown that elastic bandages across the knee raise the venous pressure in the distal circulation and act as tourniquets. 34 They recommend that elastic bandages should terminate below the knee. Sigel et al. have measured the velocity of flow in lower extremity veins using a Doppler ultrasound technique.

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