Physiological & pathological breath sounds

Emergency C Section for a Bleeding Placenta

New Minimally Invasive Procedure with No Pain or Downtime… From Dr. Michael Goodman, Caring For Women Wellness Center Laser Vaginal Tightening for Improved Sexual Pleasure and Relief from Minimal Urinary Incontinence Laser Vaginal Therapy for reversing Vaginal Atrophy (Good also for Breast Cancer Survivors with Vaginal Atrophy)

Cobalamin (vitamin B12) deficiency is particularly common in the elderly (>65 years of age), but is often unrecognized because of its subtle clinical manifestations; although they can be potentially serious, particularly from a neuropsychiatric and hematological perspective.

SEX WITH DIAPHRAGM TO CONTROL UNWANTED PREGNANCY

Exercises. Light exercises in which you move your affected limb may encourage lymph fluid drainage and help prepare you for everyday tasks, such as carrying groceries. ...

Initial symptoms may include: Pain or discomfort in the upper tummy (abdomen), especially after eating. Indigestion. (Note: most people who have indigestion do not have stomach cancer.) Feeling sick, and being off food. ... Weight loss and/or loss of appetite. You may pass blood out with your stools (faeces).

Rectal Examination

This video, Rheumatoid arthritis is a chronic inflammatory disorder that can affect more than just your joints. In some people, the condition also can damage a wide variety of body systems, including the skin, eyes, lungs, heart and blood vessels. An autoimmune disorder, rheumatoid arthritis occurs when your immune system mistakenly attacks your own body's tissues. Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining of your joints, causing a painful swelling that can eventually result in bone erosion and joint deformity. The inflammation associated with rheumatoid arthritis is what can damage other parts of the body as well. While new types of medications have improved treatment options dramatically, severe rheumatoid arthritis can still cause physical disabilities.

Ankylosing spondylitis is an inflammatory disease that, over time, can cause some of the vertebrae in your spine to fuse. This fusing makes the spine less flexible and can result in a hunched-forward posture. If ribs are affected, it can be difficult to breathe deeply. Ankylosing spondylitis affects men more often than women. Signs and symptoms typically begin in early adulthood. Inflammation also can occur in other parts of your body — most commonly, your eyes. There is no cure for ankylosing spondylitis, but treatments can lessen your symptoms and possibly slow progression of the disease.

Pyogenic granuloma (lobular capillary hemangioma[1] ) is a relatively common benign vascular lesion of the skin and mucosa whose exact cause is unknown. Also see the Medscape Reference article Oral Pyogenic Granuloma. Pyogenic granulomas are misnamed; they are neither infectious nor granulomatous. The lesion usually occurs in children and young adults as a solitary, glistening red papule or nodule that is prone to bleeding and ulceration. Pyogenic granulomas typically evolve rapidly over a period of a few weeks, most often on the head, neck, extremities, and upper trunk. Pyogenic granuloma often arises in pregnancy (or rarely with oral contraceptive usage), particularly on the gingiva or elsewhere in the oral mucosa, and then is termed the "pregnancy tumor." Other pyogenic granuloma variants that have been well documented include the disseminated, subcutaneous, intravenous, and medication-induced (for example, retinoid, antiretroviral, and oncologic agent) subtypes. Removal of pyogenic granuloma is indicated to alleviate any bleeding, discomfort, cosmetic distress, and diagnostic uncertainty. A number of malignant tumors may clinically mimic pyogenic granuloma, making histopathologic confirmation important if the presentation is atypical. Aside from cutaneous and oral lesions, pyogenic granuloma has been reported throughout the gastrointestinal tract and upper airway, at various ocular locations, the central nervous system, the bladder, and the internal vasculature. This article discusses only cutaneous and oral involvement.

The Blood Flow In Leg

A nose job (technically called a rhinoplasty) is surgery on the nose to change its shape or improve its function. It can be done for medical reasons -- such as to correct breathing problems related to the nose or correct disfigurement resulting from trauma or birth defects. It can also be done for cosmetic reasons, which will change the nose's shape and appearance.

Tampon for The First Time

The examination room should be quiet, warm and well lit. After you have finished interviewing the patient, provide them with a gown (a.k.a. "Johnny") and leave the room (or draw a separating curtain) while they change. Instruct them to remove all of their clothing (except for briefs) and put on the gown so that the opening is in the rear. Occasionally, patient's will end up using them as ponchos, capes or in other creative ways. While this may make for a more attractive ensemble it will also, unfortunately, interfere with your ability to perform an examination! Prior to measuring vital signs, the patient should have had the opportunity to sit for approximately five minutes so that the values are not affected by the exertion required to walk to the exam room. All measurements are made while the patient is seated. Observation: Before diving in, take a minute or so to look at the patient in their entirety, making your observations, if possible, from an out-of-the way perch. Does the patient seem anxious, in pain, upset? What about their dress and hygiene? Remember, the exam begins as soon as you lay eyes on the patient. Temperature: This is generally obtained using an oral thermometer that provides a digital reading when the sensor is placed under the patient's tongue. As most exam rooms do not have thermometers, it is not necessary to repeat this measurement unless, of course, the recorded value seems discordant with the patient's clinical condition (e.g. they feel hot but reportedly have no fever or vice versa). Depending on the bias of a particular institution, temperature is measured in either Celcius or Farenheit, with a fever defined as greater than 38-38.5 C or 101-101.5 F. Rectal temperatures, which most closely reflect internal or core values, are approximately 1 degree F higher than those obtained orally. Respiratory Rate: Respirations are recorded as breaths per minute. They should be counted for at least 30 seconds as the total number of breaths in a 15 second period is rather small and any miscounting can result in rather large errors when multiplied by 4. Try to do this as surreptitiously as possible so that the patient does not consciously alter their rate of breathing. This can be done by observing the rise and fall of the patient's hospital gown while you appear to be taking their pulse. Normal is between 12 and 20. In general, this measurement offers no relevant information for the routine examination. However, particularly in the setting of cardio-pulmonary illness, it can be a very reliable marker of disease activity. Pulse: This can be measured at any place where there is a large artery (e.g. carotid, femoral, or simply by listening over the heart), though for the sake of convenience it is generally done by palpating the radial impulse. You may find it helpful to feel both radial arteries simultaneously, doubling the sensory input and helping to insure the accuracy of your measurements. Place the tips of your index and middle fingers just proximal to the patients wrist on the thumb side, orienting them so that they are both over the length of the vessel.

Lumbar puncture is a common emergency department procedure used to obtain information about the cerebrospinal fluid (CSF) for diagnostic and, less commonly, therapeutic reasons. Please refer to the full article on Lumbar Puncture for more details on the lumbar puncture procedure. Lumbar puncture is typically performed via “blind” surface landmark guidance. The surface landmark technique is reported to be successful in a high percentage of attempted lumbar punctures; however, surface landmark identification of underlying structures has been shown to be accurate only 30% of the time. [1] Unsuccessful identification of proper landmarks often leads to increased difficulty in obtaining CSF, if the procedure is performed, and a higher rate of complications. Few alternatives are available in these cases. If available, fluoroscopic-guided lumbar puncture may be performed. If not, treatment is sometimes initiated empirically without obtaining CSF. Disadvantages of using fluoroscopy include limited availability or necessary transport of the patient outside of the emergency department, inability to directly visualize the spinal canal, and inherent radiation exposure

Future Technologies and Medical Advances That Will Change The World

The management of acute ischemic stroke has advanced greatly over the past 2 decades. New interventions, including intravenous and endovascular treatment strategies, have evolved to recanalize arteries and salvage the ischemic brain. The evolution of interventional approaches to the treatment of acute stroke has been prompted by the limitations of intravenous therapy and intended to extend the treatment window, improve recanalization rates, and subsequently long-term clinical outcomes. The major techniques that have defined the current field of interventional acute stroke management and the relevant past and current data, and ongoing clinical trials on interventional stroke therapy will be reviewed. New issues, such as futile recanalization, and time to microcatheter, will also be discussed.

A simple test of fingernail clippings could replace a blood draw as a way to diagnose and monitor type 2 diabetes mellitus (T2DM), with huge implications for tracking the disease in the developing world. Research on this method by a team of Belgian researchers was reported July 28, 2015, at the 2015 American Association for Clinical Chemistry (AACC) Annual Meeting and Clinical Lab Expo in Atlanta. The team, led by Joris R. Delanghe, MD, PhD, of the Department of Global Chemistry, Microbiology and Immunology at Ghent University, collected nail clippings from 25 people with T2DM and 25 without the disease. The clippings were ground into a powder and tested with an inexpensive FT-IR photometer to measure how much the protein in the nails had bonded with sugar molecules, a process known as glycation. “We found a striking difference in the measurements between the control group and the patients with diabetes,” Delanghe said. In an interview with Evidence-Based Diabetes Management, he said replacing the standard blood test to measure glycated hemoglobin is a huge advantage. In many cultures, he said, “Taking blood is something that cannot be tolerated.” - See more at: http://www.ajmc.com/journals/evidence-based-diabetes-management/2015/september-2015/fingernail-tests-may-offer-cheap-simple-way-to-diagnose-diabetes#sthash.XQxnBcNO.dpuf

The physical signs of pregnancy are easy to recognize -- nausea, fatigue, that swollen belly and (often) a healthy glow. But what if you had these telltale pregnancy symptoms -- and weren't actually pregnant? As crazy as it sounds, it does happen. False pregnancy, or pseudocyesis, is a condition in which a woman believes that she's pregnant, yet conception hasn't taken place and no baby is forming inside. Common, and often lasting, pregnancy symptoms help to reinforce this idea, which can lead a woman to be absolutely certain she's expecting, for months or even years!