tailieunhanh - Practical Plastic Surgery - part 10

Cái dá khối quản lý của tĩnh mạch phentolamine, một chất đối kháng thụ thể alpha-adrenergic, nên sản xuất phong tỏa thông cảm. Nếu các dấu hiệu và triệu chứng thông cảm qua trung gian như trong trường hợp của RSD, họ nên làm giảm đáp ứng với truyền này. Điều quan trọng là quản lý nước muối một cách mù để loại bỏ hiệu ứng giả dược. | Reflex Sympathetic Dystrophy 603 Intravenous alpha-Adrenergic Blockade Bier block administration of intravenous phentolamine an alpha-adrenergic receptor antagonist should produce sympathetic blockade. If the signs and symptoms are sympathetically-mediated as in the case of RSD they should diminish in response to this infusion. It is important to administer saline in a blinded fashion to eliminate the placebo effect. Classification Lankford classified RSD into five categories Minor causalgia A mild form of RSD seen after injury to a sensory nerve in the forearm hand or fingers. Major causalgia The more severe form of causalgia in which pain and dysfunction are prominent. It occurs as a result of injury to mixed motor and sensory nerve. Minor traumatic dystrophy Mild RSD with an inciting trauma but no known nerve injury. Major traumatic dystrophy The form most commonly thought of when the term RSD is used. Seen after trauma or fracture of the upper extremity without specific nerve involvement. Shoulder and hand syndrome RSD due to remote injury such as an MI or cervical spine injury. Symptoms begin in the shoulder and spread to the hand sparing the elbow. SMPS can be classified into Type I and II Type I What is thought of when the term RSD is used. Pain follows and inciting event and is out of proportion to the exam. The other findings typically associated with RSD are usually present. Type II This type of SMPS describes causalgia similar to the definition given in the Lankford classification. Stagmg RSD can also be thought of in terms of its stage early established or late. Early RSD Defined as the first three months of symptoms. Pain is often burning and can be caused be even light touch. Discoloration hyperhydrosis and increased temperature are often present. Established RSD Defined as the period between three and twelve months of symptoms. Pain is still the dominant feature. Skin dryness joint stiffness contractures and osteoporosis are common. The temperature .