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Copy of Prezi Template - My Desk

Use this template to create a birds eye view of your desk
by

MiKyung Baek

on 26 June 2013

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Transcript of Copy of Prezi Template - My Desk

(cc) photo by Metro Centric on Flickr
(cc) photo by Franco Folini on Flickr
(cc) photo by Metro Centric on Flickr

Objectives

Leg Ulcer Management


- Cause

- Diagnosis


- Treatment
Add text

Percutaneous Transluminal Angioplasty
(PTA)
Walking Program

- 혈관 형성 자극, 혈류 개선 효과

- At least 30 min of moderate
exercise 3 to 4times/wk

- Walking, cycling, jogging,
lifestyle and work activities

Add text
Yonsei University Health System Severance Hospital
Mi Kyung Baek
5-Year Natural History of Intermittent Claudication
Arterial ulcer
- Peripheral arterial disease
(PAD)
: 관상동맥을 제외한 brain, visceral
organ, & limb 전신 동맥질환

- Peripheral arterial occlusive disease
(PAOD)
: 전신의 말초 동맥혈관의 폐색

- Lower extremity arterial disease
(LEAD)
: 하지의 동맥혈관 폐색

Risk factors
Obesity
Inactivity
Stress
Advanced age
Male gender

- Postmenopausal status:
“atheroprotective” effects of estrogen
Age

- Age less than 50yrs with DM and
atherosclerosis
- Age 50 to 69yrs and smoking or DM
- Age 70 and older
Pain; First indication of PAD

-
Intermittent claudication:
중간~심한 운동 후 2~5분 휴식으로 통증
완화, 50% 혈관 폐쇄 시 발생

- Nocturnal pain: 혈관 폐쇄 악화를
의미, 침대 휴식 시,
심박출량 감소와 다리를 올린 상태에서
발생

- Rest pain: 활동량 없을 때,
진행된 폐쇄성 질환
Diagnosis
Ankle Brachial Index(ABI)
Doppler and Duplex Ultrasonography
Pulse Volume Recording (PVR)
Transcutaneous oxygen(TcPO2)
Angiography
CT Angiography
MR Angiography

Venous Ulcer
정맥순환은 제 2의 심장이라 할 수 있는 Calf muscle pump의 강한 수축에
의해 이루어짐


Venous Ulcer
Venous Ulcer
Valvular Dysfunction

Obesity: pressure on pelvic vein venous return 저항

Pregnancy: 호르몬 변화로 근육이완과 함께 혈관 이완

DVT: 염증반응, valve 손상의
직접적 원인, 허리디스크 후에
발생

Orthopedic injury

Calf Muscle Dysfunction

Sedentary lifestyle

Prolonged standing

Paralysis, arthritis

Advanced age

Matrix Partners preso!
Harvard Business Review
xxx
And why it happened
=
Instead this is
what happened
And now I have
BIG Problem!
This is the result
xxx
S
_ _ _ _ _ _ _ _ _ _
a
s
e
m
e
d
xxx
@IndoJacco
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Enjoy!

정맥성 궤양은

Valve의 기능 이상!!

Calf Muscle의 기능 이상!!!

만유인력의 법칙 작용


Management
- Compression banding으로 superficial vein
압박 calf muscle 지지, 혈관 내강을 좁혀 혈류
증가

Diagnosis

- Toniquet test: 20초 이내 refill
- Doppler
- Venogram
DFU
(Diabetic Foot Ulcer)
Amputation is a simple way to control infection. However……

Diabetic Foot amputation(major)

The fate of second leg 50% of second leg amputation within 5 years

Mortality after major amputation
39-65% within 5 years
cf) colon cancer: 5 year survivor rate
; 61-70.1%(2008)

Neuropathy

Vasculopathy

Neuropathy
Neuropathy
VIPS Approach

V
ascular assessment and treatment
I
nfection Control
- Proper Antibiotics
- Multi Organism Infection
P
ressure Off
- Shoe and Insole correction
- TCC
S
pecial Wound Care
- Sufficient Debridement
- NPWT
- Growth factor
- Dressing materials
(Collagen, Hyaluronic Acid dressing)
- Cell Therapy(Kaloderm, AlloDerm)


감사합니다.
International Working Group on the Diabetic Foot(IWGDF)

Multidisciplinary team approach


Internal medicine, diabetology, infectious disease,
medical microbiology, vascular surgery, podiatry,
plastic surgery, emergency medicine, nursing,
prosthetics/orthotics, and physical therapy
Full transcript