Download Psoas and Quadratus Lumborum Muscle Injections: Fluoroscopy

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Peritoneal dialysis
Althea Mahon, Karen Jenkins, and Lisa Burnapp
Print Publication Year: 2013 Published Online: Jul 2013
ISBN: 9780199600533 eISBN: 9780191742682
Item type: chapter
Publisher: Oxford University Press
DOI: 10.1093/med/9780199600533.003.0011
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Piriformis Muscle Injections: Fluoroscopy
Robert B. Bolash and Kenneth B. Chapman
Print Publication Year: 2016 Published Online: Oct 2016
ISBN: 9780199908004 eISBN: 9780199392629
Item type: chapter
Publisher: Oxford University Press
DOI: 10.1093/med/9780199908004.003.0046
Piriformis syndrome is an entrapment neuropathy caused by compression or irritation
of the sciatic nerve as it courses in proximity to the piriformis muscle. Conservative
treatment modalities for piriformis syndrome include the use of anti-inflammatory analgesic
medications or muscle relaxants. Physical therapy is often employed to correct the abnormal
pelvic biomechanics and focus on stretching the piriformis muscle. Prior to proceeding with
invasive surgical approaches, this chapter advocates the use of piriformis muscle injection.
The technique both confirms the diagnosis and offers therapeutic value while avoiding
the risks, expense, and potential adverse outcomes associated with surgical interventions.
A combined fluoroscopic and nerve stimulator guided technique is recommended to
identify bony landmarks, verify the perisciatic location, confirm intramuscular spread of
the injectate, and avoid intravascular injection of particulate steroid. Transient sciatic nerve
block caused by spillover of the local anesthetic administered into the piriformis muscle is a
common complication.
Piriformis Muscle, Psoas Muscle, and Quadratus Lumborum Muscle Injections:
Ultrasound
Hariharan Shankar and Karan Johar
Print Publication Year: 2016 Published Online: Oct 2016
ISBN: 9780199908004 eISBN: 9780199392629
Item type: chapter
Publisher: Oxford University Press
DOI: 10.1093/med/9780199908004.003.0047
This chapter describes the anatomy, technique, available evidence, and complications of
piriformis, psoas, and quadratus lumborum muscle injections. Traditionally landmarkPage 1 of 4
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date: 06 May 2017
based injections of the piriformis muscle were performed using the posterior inferior
iliac spine and the greater trochanter as bony landmarks. Subsequently, fluoroscopy,
electromyography, and CT were used to facilitate the injection. Activation of myofascial
trigger points within the iliopsoas muscle can cause referred pain to the groin and anterior
thigh. Landmark-based injections and CT-guided iliopsoas injections have been described.
But they carry the risk of radiation, bowel injury, intravascular injection, and nerve injury.
Ultrasound-guided injection into the psoas muscle may be performed at two different
locations, the iliopsoas muscle and the iliopsoas tendon. The quadratus lumborum is a
common cause of low back pain, and ultrasound-guided injection of local anesthetic into
quadratus lumborum muscle may be performed.
Planning for the actual death
Patricia Berry and Julie Griffie
Print Publication Year: 2015 Published Online: Jan 2015
ISBN: 9780199332342 eISBN: 9780199385225
Item type: chapter
Publisher: Oxford University Press
DOI: 10.1093/med/9780199332342.003.0032
The care of patients and families near to death and afterward is an important nursing
function—arguably one of the most important things nurses do. At the end of life,
nurses and other healthcare professionals often only have one chance to “get it right.”
Assessment and aggressive management of symptoms must remain a priority, especially
as death approaches. Goals of care inevitably change in rhythm with patient and family
needs and wishes. Care of the body after death, including normalizing and interpreting
postmortem changes and honoring rituals and individual requests, is critically important in
communicating to family members and close others that the person who died was indeed
important and valued.
Poisoning
Heather Baid, Fiona Creed, and Jessica Hargreaves
Print Publication Year: 2016 Published Online: Mar 2016
ISBN: 9780198701071 eISBN: 9780191770548
Item type: chapter
Publisher: Oxford University Press
DOI: 10.1093/med/9780198701071.003.0017
This chapter reviews the assessment of the critically ill patient presenting with poisoning
from a harmful substance. Particular attention is paid to a focused history, a focused
physical assessment, and relevant laboratory investigations. The critical care nursing
management during the initial period is described, as well as interventions to minimize
further absorption and promote excretion of the poison. A list of common toxidromes and
their signs and symptoms is also provided. Definitions, assessment findings, investigations,
management, and available antidotes are then described for a range of specific substances
that are common causes of poisoning, including paracetamol, salicylate, carbon monoxide,
and tricyclic antidepressants, as well as illicit drug overdose.
Page 2 of 4
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date: 06 May 2017
Poor, homeless, and underserved populations
Anne Hughes
Print Publication Year: 2015 Published Online: Jan 2015
ISBN: 9780199332342 eISBN: 9780199385225
Item type: chapter
Publisher: Oxford University Press
DOI: 10.1093/med/9780199332342.003.0039
The purpose of this chapter is to consider characteristics of the poor as an underserved
population that place them at risk when seriously ill and when palliative care is indicated. In
particular, this chapter looks at a subset of the poor who are homeless. This chapter focuses
on persons whose “membership” in this group is more long term and not the result of an
identifiable global economic crisis; similarly, this chapter does not address the experiences
of persons living in extreme poverty in resource-limited countries around the globe.
Post-operative complications
Claire Perkins
Print Publication Year: 2016 Published Online: May 2016 Publisher: Oxford University Press
ISBN: 9780199642663 eISBN: 9780191742835
DOI: 10.1093/med/9780199642663.003.0015
Item type: chapter
Surgical patients are at risk of post-operative complications. A thorough pre-operative
assessment and the implementation of appropriate care/treatment plans will reduce the
likelihood of complications occurring. The surgical nurse should have a good knowledge
and understanding of recognizing, preventing, and treating post-operative complications.
The ABCDE approach should be used in the immediate post-operative period and if the
patient becomes acutely unwell. This chapter uses body systems and the ABCDE approach
to review post-operative complications.
Pre-operative assessments and preparation
Mark Radford
Print Publication Year: 2016 Published Online: May 2016 Publisher: Oxford University Press
ISBN: 9780199642663 eISBN: 9780191742835
DOI: 10.1093/med/9780199642663.003.0004
Item type: chapter
Advances in surgery have been combined with innovation in anaesthesia techniques.
Chapter 3 highlights the increasingly flexible models of surgical care delivery and the
role of the nurse in these care settings. Preparation prior to surgery is increasingly being
delivered by nurses in the pre-operative phase of care. The knowledge requirements of the
nurse in this field are complex, involving a greater understanding of applied physiology
and pharmacology, pre-operative testing methods, and assessment modalities. This chapter
guides the nurse in the assessment process, choice of diagnostic tests, and preparation of the
patient physically and psychologically for surgery.
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date: 06 May 2017
Pre-operative optimization
Mike Phillips
Print Publication Year: 2016 Published Online: May 2016 Publisher: Oxford University Press
ISBN: 9780199642663 eISBN: 9780191742835
DOI: 10.1093/med/9780199642663.003.0005
Item type: chapter
Once a patient has been admitted for surgery, depending upon their pre-operative
assessment, they may require a period of optimization in hospital before surgery. Preoperative optimization will focus the clinical teams on incremental adjustments to
baseline physiology and testing to ensure that the patient is in optimal clinical condition
prior to surgery. The nursing care of such patients will rely upon surgical knowledge
of body systems, such as cardiovascular and respiratory, alongside fluid and electrolyte
management, nutrition, and pharmacology. This chapter guides the nurse in the assessment
process and the skills required in the management of a high-risk surgical patient.
Principles of patient and family assessment
John D. Chovan, Douglas Cluxton, and Patrice Rancour
Print Publication Year: 2015 Published Online: Jan 2015
ISBN: 9780199332342 eISBN: 9780199385225
Item type: chapter
Publisher: Oxford University Press
DOI: 10.1093/med/9780199332342.003.0004
A comprehensive palliative care nursing assessment of the patient and family occurs
throughout the trajectory of the illness and is a holistic view that includes the physical,
psychosocial, and spiritual domains. Patient and family assessment provides the foundation
for mutual goal setting, devising a plan of care, implementing interventions, and evaluating
the effectiveness of care. Reassessments are done throughout the patient’s illness, looking
for changes from previous assessments to ensure that quality of life is maximized in all
domains. The palliative care nurse understands above all that, irrespective of the phase or
focus of the assessment, two of the most important assessment questions the nurse can ask
the patient and family are “What is your greatest concern?” and “How can I be of help?”
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Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Medicine Online
for personal use (for details see Privacy Policy).
date: 06 May 2017