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Damn Brutal 😵💯

Does anyone have schizophrenia here? What does it exactly do to the patient?

Prior to transfer to a psychiatric unit, the SQH and aspirin were discontinued and patient was started on pentoxifylline 400 mg TID to improve perfusion to penis. Ad 👉 Support me 👈 >>Approximately 10 weeks after index injury, plastic surgery performed a 0.012”-split-thickness skin graft to the shaft using 110 cm2 from the lateral thigh, sutured in place with 4-0 chromic interrupted sutures. The graft healed with-out any complications. Once the graft was fully epithelialized, the patient started using a penile pump daily to prevent the loss of penile length. >>From arrival in our ED, the psychiatry team was involved. He had been diagnosed with schizophrenia approximately 1 year prior but had not been compliant with his home antipsychotics (risperidone, later switched to paliperidone, and then long-acting injectable paliperidone). He had a family history significant for suicide by multiple paternal relatives and father with bipolar disorder. Before his self-mutilation, he had been a missing person while living undomiciled. He had a history of paranoid and persecutory delusions and suicidal ideations; there was no record of prior gender dysphoria. Daily assessment was performed by psychiatry and urology, and he was told that with improvement, he could be enrolled in a transgender program. After the index surgery, the patient initially stated that he had wanted gender affirmation surgery but had disorganized thoughts and poor understanding of his condition. Initially, he continued to endorse auditory hallucinations commanding him to amputate his genitalia; however, after the psychosis had resolved, he denied gender dysphoria. His antipsychotics were initially risperidone 1 mg twice daily and over the next 2 months up-titrating to 8 mg twice daily and then cross-tapered to clozapine 425 mg daily augmented with lithium 1200 mg daily until therapeutic levels met. He was discharged to a long-term psychiatric facility on lithium 600 mg twice daily, clozapine 150 mg q-AM and 275 mg QHS, and sertraline 150 mg q-AM. Ad 👉 Support me 👈 >>The patient presented for follow-up at 12 months after the index surgery. He was still under psychiatric treatment. He denied being able to ejaculate; however, he was not self-stimulating and denied sexual activity. The patient did endorse tumescence although it was not yet adequate for penetration. Penile sensation was present although reduced. The skin graft was well-healed, the testis was palpable albeit atrophic, and the urethral meatus was patent (Figure 4). He was continued on testosterone replacement therapy (testosterone 339.7 ng/dL) and penile vacuum therapy. He was advised to use penile vibratory stimulation to help him reach orgasm if needed. He denied any gender dysphoria nor desire for gender affirmation surgery and identified himself as a heterosexual male.

A 23-year-old male with a past medical history of Celiac disease, hypothyroidism, homelessness, and prior in-patient treatments for schizophrenia presented to our institution after having amputated his penis, testicles, and most of his scrotum with a serrated knife. This was done in a public area, 20 minutes prior to arrival after taking two ibuprofens. The penile shaft, both testes, and scrotal skin were brought on ice with the patient by the EMT (Figure 1). >>Upon arrival, the massive bleeding from the penile stump/groin was controlled by applying pressure with with epinephrine-socked gauze and the patient was stabilized according to trauma protocol. He denied hallucinations and suicidal ideations. He was withdrawn, had affective flattening, disorganized speech, and difficulties organizing his thoughts. He stated that he was homeless and was undergoing gender affirmation surgery but did not supply details. He did not want his penis to be re-implanted nor his family to be informed. He had dramatically diminished sensation of pain given his injury. His toxicology screen was negative. On examination, his penis was amputated at the base. He was given a third-generation cephalosporin and tetanus-diphtheria-acel pertussis vaccine. The prior psychiatric history of the patient could not be obtained at this time and was later hindered by the family's denial that he suffered from schizophrenia. The ED psychiatrist, the attending trauma surgeon, the reconstructive urologist (DAP), and the administrator-on-call all agreed that the patient was in an acute psychosis and lacked legal capacity to refuse emergent medical treatment. He was taken emergently to the operating room for microsurgical replantation. Aspirin therapy was started, and subcutaneous heparin (SQH) 5000 units TID was initiated. Prior to induction, he again stated that he was a transgender woman, refused reattachment, however, did desire for us to control the bleeding. Surgical details are described in the Appendix S1. Ad 👉 Support me 👈 >>After the index surgery, the patient was transferred to the surgical intensive care unit for graft perfusion monitoring. To increase penile perfusion, he was started on tadalafil 5 mg daily. Of note, the patient started to experience morning erections of the proximal and partial erections of the distal shaft within 2 weeks from reconstruction. >>Postoperative testosterone was 67 ng/dL, and he was started on replacement with testosterone enanthate IM 200 mg every 10 days. Given the contaminated nature of the wound, he was continued on IV antibiotics (switched to oral after 5 days and then continued for 6 days). >>Given prior history of hypothyroidism, his thyroid function was evaluated; his thyroid-stimulating hormone (TSH) was >150 uIU/mL and free T4 was 0.3 ng/dL. Levothyroxine was continued and increased to an appropriate dose. >>Five days after the index surgery, the patient developed classic venous skin congestion (Figure 2A) and twice-daily medical leech therapy was initiated (one placed ventrally and once dorsally and allowed to imbibe until they fell off). This initially helped reduced the ecchymosis and hematoma (Figure 2B); however, it was stopped after 1 week when skin necrosis developed (Figure 2C). The SPY Fluorescence Imaging System (Stryker) confirmed no perfusion. As the penile skin started to form an eschar, wound care consisted of twice-daily application of MediHoney gel (Derma Sciences) to eschar and Aquacel strips (ConvaTec) to exposed tissues. Daily bedside wound debridement was performed to remove necrotic skin and eschar. >>Two weeks after the index surgery, the patient underwent a retrograde urethrogram (RUG) showing no stricture nor extravasation (Figure 3); the Foley catheter was removed. He had no postvoid residual and voided without difficulty. Two weeks later, he was transferred to the psychiatric unit with continued local wound care awaiting eventual skin grafting.

A patient with schizophrenia cut their penis and testicles off. They were reattached.

Don't go into open road while drunk 🤡💯😵

Who wanna see Drunk man falls into boiling pot in India Again India! 🤡🤡

>>The patient was a 32-year-old male chemical factory worker without any notable medical history. While servicing a machine, the patient contacted a 380 V electric current through his left arm and subsequently fell unconscious. During his fall, he knocked over a barrel filled with sulfuric acid. The 98% sulfuric acid continuously poured over the left side of his neck and chest, and caused combined electrical and sulfuric acid burn injuries (25% of his total body surface area). However, the residual sulfuric acid was not removed until he was brought to the local hospital 32 min later. >>At 11 h after the injury, he was transferred to our hospital. His arterial blood gas analysis revealed a pH of 7.15, a PO2 of 297 mmHg, a PCO2 of 32 mmHg, HCO3− levels of 11.4 mmol/L, and a −17 base excess in the extracellular fluid compartment. The pH of his wound exudates was 5. Our examination revealed that numerous portions of the left neck and chest muscles were necrotic. The left clavicle was also clearly exposed and necrotic, and a cavity was present above the left supraclavicular fossa (Figure 1). The majority of the left forearm muscle group was necrotic, which had resulted in total loss of the left arm’s sensory and motor functions. Our diagnoses were burns (both electrical and concentrated sulfuric acid) to 25% of his total body surface area, with third-degree (18%) and fourth-degree (7%) burns to his head, torso, and limbs. >>On the second day of admission, escharotomy was performed on the patient’s torso and left arm. The left subclavian vein was found to be embolized and fractured. In addition, the left brachial plexus had necrotized, whereas the left subclavian artery was still pulsing (Figure 2). Therefore, we ligated the left subclavian artery and vein. The wound was filled with hydrophilic silver ion-containing dressings (AquacelAg®; ConvaTec, US) to facilitate wound drainage. Three days after the surgery, the patient started consuming some fluid food (milk). We subsequently observed that a high volume of milky exudate was secreting from the wound near the left clavicle (Figure 3). After we verified that the milky exudate was chyle, we subsequently diagnosed the patient with thoracic duct chylous fistula. Ad 👉 Support me 👈 >>After the diagnosis was confirmed, conservative treatment was administrated to reducing the amount of chylous fistula drainage, including fasting, dietary management, and application of somatostatin. The patient also underwent several rounds of debridement. However, the severity and size of the soft tissue defects in the left neck and chest area complicated not only the seal of orificium fistulae of thoracic duct, but also the repair of the wound surfaces. Local and free flaps could not be used in this patient, which forced us to utilize unconventional flaps. Considering the urgency of surgical coverage of the necrotic wound cavities, and the reality that the patient’s left forearm, limb salvage value was judged to be lost. After most of the necrotic tissues had been removed from the wound, the distal muscle necrosis on the left arm was amputated, the distal bone of the humeral neck was removed, and the residual left arm muscles formed a huge local boneless muscle flap that was used to fill and seal the wound cavity near the left clavicle, which completely survived. After 45 days of treatment, all of the patients’ wounds were essentially sealed (Figure 4). The patient was followed-up for 1 year, and no recurrence was found. And my occasional reminder: I am poor and disabled and if you want to support my content I’ve got links in my profile for that.

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Electrical burns plus chemical burns plus thoracic duct chylous fistula in one man ☠️👀 Pictures coming

Why not just slow a bit

Play stupid games win stupid prizes Video in few minutes

Is he blind or what 😬😬👀👀

Does anyone knows the backstory 😵😵👀👀

How many already saw this brutal clip??

⚔️☠️💯 Enjoy

Swords inside mouth ⚔️⚔️☠️☠️ 💯

Indian again 😵😵😵😬😬😬

What the hell is he doing after that 👀🤡☠️🇮🇳 Video in few minutes

Case Report A 56-year-old male with a history of deep vein thrombosis and pulmonary embolism, who was on Eliquis, presented after sustaining a snakebite to his right hand from his pet Eastern Diamondback Rattlesnake. Despite receiving multiple doses of antivenom over the course of 12 hours, he developed severe compartment syndrome in his upper extremity, with compartment pressures reaching dangerously high levels. On physical exam, the patient's right upper extremity was tense and swollen, with significant hemorrhage and bruising. Given the clinical findings and the elevated compartment pressures measured using a Stryker needle, the decision was made to take the patient urgently to the operating room for fasciotomy of the hand, forearm, and upper arm. AD 👉SUPPORT ME👈 Intraoperatively, the surgeons found significant muscle herniation and signs of muscle necrosis upon release of the fascia. Over the next 13 days, the patient required 5 additional surgeries for irrigation, debridement, delayed primary closure, and skin grafting. The skin grafts were harvested from the patient's right thigh. At 2 years of follow-up, the patient had regained full range of motion and function in his upper extremity, with no wound complications. This case highlights the importance of recognizing and treating compartment syndrome in the setting of snakebite envenomation, even when antivenom has been administered. There is ongoing debate in the literature regarding the management of post-snakebite compartment syndrome. Some studies have suggested that antivenom alone is sufficient, arguing that fasciotomy does not improve outcomes. However, the authors of this case report strongly disagree, citing evidence that irreversible nerve and muscle damage can occur within 8 hours if compartment syndrome is not promptly treated with fasciotomy. The patient in this case was on the anticoagulant Eliquis, which likely compounded the venom's coagulopathic effects and contributed to the development of compartment syndrome. Prior to fasciotomy, the patient had significant coagulation abnormalities, further motivating the surgical intervention. AD 👉SUPPORT ME👈 The authors note that the use of continuous compartment pressure monitoring devices, such as the FDA-approved MY01 system, could have been helpful in this case. These devices allow for real-time, non-invasive monitoring of compartment pressures, which may aid in the diagnosis and management of compartment syndrome in the setting of snakebite. In conclusion, this case report demonstrates the critical importance of recognizing and surgically treating compartment syndrome in patients with snakebite envenomation, even when antivenom has been provided. Prompt fasciotomy can be a limb-saving intervention in such cases, and should be considered when compartment pressures remain severely elevated despite antivenom administration.