An Improved Method of Ring Removal
A number of techniques exist for the removal of rings from swollen fingers. An improved method is described using ribbon gauze and a paper clip. It is cheap, quick and effective and can be used in the presence of minor lacerations and abrasions.
The caterpillar technique for removal of a tight ring.
The lines of evidence include evolutionary, correlative, antipyretic, and hyperthermia/hypothermia studies (2). For example, infectious illnesses are of longer duration, and mortality rates increase if the fever is treated (2). Additionally, as the febrile response is highly regulated, it likely has an adaptive role (2). A second consideration is that fever represents an alteration in the thermoregulatory set point. Unless something occurs during surgery that decreases the elevated set point, the patient will attempt to return to this set point in the postoperative period. Shivering and high metabolic cost in the early postoperative period are likely to be undesirable. Also, there is some risk to administering antipyretic therapy to maintain the lower temperature, and antipyretics may be ineffective (1). A third consideration is whether maintaining a patient at an elevated temperature increases the metabolic rate. It is estimated that for every 1°C increase in temperature, the metabolic rate increases by up to 13%. This is probably offset to some extent by the decreased metabolic rate during anesthesia. This is significantly less than the potential 500% increase for the postoperative shivering patient (4). A fourth consideration is that increases in core temperature up to 41°C have never been shown to be harmful per se (5). In contrast, therapeutic hyperthermia with temperatures 42°C has been associated with tissue damage, e.g., fat necrosis. In some specific instances, a febrile state is clearly harmful. For example, in neurologic injury, carotid endarterectomy, neurosurgery, cardiac surgery, and after cardiac arrest, neurologic injury may be greater in the presence of an increased temperature (6). In pediatric patients, one has to be concerned about febrile seizures (7). Lastly, because heart rate increases as temperature increases, in patients in whom a tachycardia may be harmful (e.g., ischemic disease, valvular heart disease, obstructive cardiomyopathy, etc), decreasing the temperature can assist in treating the tachycardia. In pregnant patients, one should be concerned about the effect of hyperthermia on the fetus. Temperatures 39°C during the first 10 wk of pregnancy during organogenesis may be associated with a sixfold increased risk of neural tube defect (8). Also, although infections increase the chance of preterm labor, this may be due to the underlying disease causing cytokine release from the amniotic cells rather than the fever per se (9). In some patients, attempts to lower a patient’s temperature may be overcome by the patient’s thermal regulatory system (10). Such a futile attempt would just wastefully increase catabolism and oxygen consumption while activating the sympathetic nervous system (11). There are little data concerning how one should manage the temperature of a febrile patient undergoing surgery (12). At least one text advocates treating the elevated temperature of a febrile patient, provides no justification for doing so, and acknowledges that it may worsen the situation (10). It is possible that the correct decision may be pathogenspecific (1). Until there are outcome studies that answer this question, the individual practitioner should consider the above arguments in managing the temperature of a febrile patient.
Total Lobbying : What Lobbyists Want (and How They Try to Get It)
1. Studying lobbyists and lobbying 2. Lobbying and lobbyists in the United States: a primer 3. Public policy lobbying, part 1 4. Public policy lobbying, part 2 5. Land-use lobbying 6. Procurement lobbying 7. Summary and conclusions.