Nasal intubation, inserting an endotracheal tube through the nose, may be contraindicated in the presence of facial trauma because if there is an undiscovered fracture at the base of the skull, the tube could be forced through it and into the brain. If facial injuries prevent orotracheal or nasotracheal intubation, a surgical airway can be placed to provide an adequate airway. Although cricothyrotomy and tracheostomy can secure an airway when other methods fail, they are used only as a last resort because of potential complications and the difficulty of the procedures. A dressing can be placed over wounds to keep them clean and to facilitate healing, and antibiotics may be used in cases where infection is likely. People with contaminated wounds who have not been immunized against tetanus within five years may be given a tetanus vaccination. Lacerations may require stitches to stop bleeding and facilitate wound healing with as little scarring as possible. Although it is not common for bleeding from the maxillofacial region to be profuse enough to be life-threatening, it is still necessary to control such bleeding. Severe bleeding occurs as the result of facial trauma in 1–11% of patients, and the origin of this bleeding can be difficult to locate. Nasal packing can be used to control nose bleeds and hematomas that may form on the septum between the nostrils. Such hematomas need to be drained.
Diroximel fumarate, sold under the brand name Vumerity, is a medication used for the treatment of relapsing forms of multiple sclerosis (MS). It acts as an immunosuppressant and anti-inflammatory drug. Its most common adverse effects are flushing and gastrointestinal problems.Diroximel fumarate was approved for medical use in the United States in October 2019, and in the European Union in November 2021. Medical uses
Diroximel fumarate is used for the treatment of relapsing-remitting multiple sclerosis. In the US, it is additionally approved for other relapsing forms of MS such as clinically isolated syndrome and active secondary progressive disease. Available forms
The drug is available as a white delayed-release capsule that is resistant to gastric acid and only dissolves in the intestine. Contraindications
Under the European Unions label, the drug is contraindicated in people with progressive multifocal leukoencephalopathy (PML), a disease of the brain caused by a virus. In the US, combination with the closely related drug dimethyl fumarate is contraindicated. Side effects
No systematic studies of adverse effects under diroximel fumarate are available. The most common side effects in studies with dimethyl fumarate were flushing (in 34% of patients treated with the drug, versus 5% in the placebo group) and gastrointestinal effects such as diarrhoea (14% versus 10%), nausea (12% versus 9%), abdominal pain (9% versus 4%), vomiting (8% versus 5%), and indigestion (5% versus 3%). Three percent of patients stopped the treatment because of flushing, 4% because of gastrointestinal side effects.