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Cardiovascular Examination Clinical skills - Medical School Revision - Dr Gill
The cardiac exam is one of the clinical skills that medical students learn completely, as more often than not, patients will consult regularly about chest pain, and it is important to be able to identify key cardiovascular signs
As a junior doctor, the examination of the cardiovascular system can be almost a dreaded examination, as cardiac murmurs can literally take years of exposure in order to gain confidence with their identification through cardiac auscultation.
This video demonstrates not merely the examination of the heart, but the complete cardiovascular system including its peripheries.
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Since the first replant more than 50 years ago, thousands of severed body parts have been reattached, preserving the quality of life for thousands of patients through improved function and appearance that the void remaining after amputation cannot provide. Ronald Malt performed the first replantation on May 23, 1962 at Massachusetts General Hospital on a 12-year-old boy who had his right arm amputated in a train accident. [1, 2] This amputation occurred at the level of the humeral neck.
Amniotomy is the official term for artificially breaking the bag of waters during labor. It is believed that breaking the bag of waters will help to speed up an otherwise slow labor. Amniotomy is part of the Active Management of Labor practiced in some hospitals. Amniotomy is performed by a midwife or doctor. A long, thin instrument with a hook on the end is inserted into the vagina and through the cervix so it can catch and rip the bag of waters. To perform an amniotomy, the cervix must be dilated enough to allow the instrument through the cervix, generally at least a two. Why choose Amniotomy? Unlike other medical methods of starting labor, amniotomy does not add synthetic hormones to your labor. Instead it seems to stimulate your body’s own labor process. Amniotomy allows the use of an internal electronic fetal monitor. How effective is Amniotomy? Amniotomy alone is unpredictable, it may take hours for labor to start with amniotomy. Because amniotomy increases the risk for infection, most caregivers use amniotomy in combination with synthetic oxytocin. Birth does happen faster when amniotomy is combined with synthetic oxytocin than when amniotomy is used alone. Risks of Amniotomy Risks for Mother Increases the risk for infection. This risk is increased with length of time the waters are broken and with vaginal exams. Because of the infection risk, a time limit is given by which the mother must give birth. As the time limit approaches attempts to progress labor will become more aggressive. The fore waters equalize pressure on the cervix so it will open uniformly. When they are broken, the mother increases her chances of having uneven dilation. Risks for Baby Increases the risk of umbilical cord compression. The fore waters equalize pressure on the baby’s head as it presses against the cervix. When they are broken, the pressure on the baby’s head may be uneven causing swelling in some parts.
At one time, women who had delivered by cesarean section in the past would usually have another cesarean section for any future pregnancies. The rationale was that if allowed to labor, many of these women with a scar in their uterus would rupture the uterus along the weakness of the old scar. Over time, a number of observations have become apparent: Most women with a previous cesarean section can labor and deliver vaginally without rupturing their uterus. Some women who try this will, in fact, rupture their uterus. When the uterus ruptures, the rupture may have consequences ranging from near trivial to disastrous. It can be very difficult to diagnose a uterine rupture prior to observing fetal effects (eg, bradycardia). Once fetal effects are demonstrated, even a very fast reaction and nearly immediate delivery may not lead to a good outcome. The more cesarean sections the patient has, the greater the risk of subsequent rupture during labor. The greatest risk occurs following a “classical” cesarean section (in which the uterine incision extends up into the fundus.) The least risk of rupture is among women who had a low cervical transverse incision. Low vertical incisions probably increase the risk of rupture some, but usually not as much as a classical incision. Many studies have found the use of oxytocin to be associated with an increased risk of rupture, either because of the oxytocin itself, or perhaps because of the clinical circumstances under which it would be contemplated. Pain medication, including epidural anesthetic, has not resulted greater adverse outcome because of the theoretical risk of decreasing the attendant’s ability to detect rupture early. The greatest risk of rupture occurs during labor, but some of the ruptures occur prior to the onset of labor. This is particularly true of the classical incisions. Overall successful vaginal delivery rates following previous cesarean section are in the neighborhood of 70 This means that about 30of women undergoing a vaginal trial of labor will end up requiring a cesarean section. Those who undergo cesarean section (failed VBAC) after a lengthy labor will frequently have a longer recovery and greater risk of infection than had they undergone a scheduled cesarean section without labor. Women whose first cesarean was for failure to progress in labor are only somewhat less likely to be succesful in their quest for a VBAC than those with presumably non-recurring reasons for cesarean section. For these reasons, women with a prior cesarean section are counseled about their options for delivery with a subsequent pregnancy: Repeat Cesarean Section, or Vaginal Trial of Labor. They are usually advised of the approximate 70successful VBAC rate (modified for individual risk factors). They are counseled about the risk of uterine rupture (approximately 1in most series), and that while the majority of those ruptures do not lead to bad outcome, some of them do, including fetal brain damage and death, and maternal loss of future childbearing. They are advised of the usual surgical risks of infection, bleeding, anesthesia complications and surgical injury to adjacent structures. After counseling, many obstetricians leave the decision for a repeat cesarean or VBAC to the patient. Both approaches have risks and benefits, but they are different risks and different benefits. Fortunately, most repeat cesarean sections and most vaginal trials of labor go well, without any serious complications. For those choosing a trial of labor, close monitoring of mother and baby, with early detection of labor abnormalities and preparation for
The typical radiograph is of a well-defined, rounded, retrocardiac opacity with an air-fluid level. In this image, the radiolucent gas is highlighted in blue, while the gastric contents are highlighted in the green. In many cases of hiatal hernia, there will not be an air bubble below the left hemidiaphragm. This is a relatively expected finding considering that the stomach is no longer in its usual position. The anatomical position of the herniated organ can be further elucidated on the lateral radiograph. Here we can see that the stomach is in the middle mediastinum posterior to the heart and above the diaphragm. Hiatal hernias can look similar to a retrocardiac lung abscess or another cavitary lesion, but it will change in size and shape between radiographs. Large hernias can shift the mediastinum to the right and result in a widening of the carinal angle. They can even give the appearance of cardiomegaly. In this radiograph, the cardiac silhouette is distinctly visible within the confines of the hiatal hernia. To review, a hiatal hernia on an AP chest radiograph typically appears as a round retrocardiac opacity with an air-fluid level.
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Disclaimer: All the information provided by Medical Education for Visual Learners and associated videos are strictly for informational purposes only. It is not intended as a substitute for medical advice from your health care provider or physician. It should not be used to overrule the advice of a qualified healthcare provider, nor to provide advice for emergency medical treatment. If you think that you or someone that you know may be suffering from a medical condition, then please consult your physician or seek immediate medical attention.
Transurethral resection of the prostate (also known as TURP, plural TURPs and as a transurethral prostatic resection TUPR) is a urological operation. It is used to treat benign prostatic hyperplasia (BPH). As the name indicates, it is performed by visualising the prostate through the urethra and removing tissue by electrocautery or sharp dissection. This is considered the most effective treatment for BPH. This procedure is done with spinal or general anesthetic. A large triple lumen catheter is inserted through the urethra to irrigate and drain the bladder after the surgical procedure is complete. Outcome is considered excellent for 80-90% of BPH patients. Because of bleeding risks associated with the surgery, TURP is not considered safe for many patients with cardiac problems. As with all invasive procedures, the patient should first discuss medications they are taking with their doctor, most especially blood thinners or anticoagulants, such as warfarin (Coumadin), or aspirin. These may need to be discontinued prior to surgery. Postop complications include bleeding (most common), clotting and hyponatremia (due to bladder irrigation).
Additionally, transurethral resection of the prostate is associated with low but important morbidity and mortality.
This is how Paraumbilical hernia looks like and how it is examined although it looks very simple but in exam it can be very difficult to perform all steps in small amount of time. This can be short case or even long of #cpsp #fcps #mbbs #medicalstudent #mbbsexams #plab2 #plab #plab1 and MS #genernalknowledge #surgery exams
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#umbilical hernia #paraumbilical #hernia repair#laparoscopic paraumbilical hernia repair. #umbilical defect, #vetral hernia surgery. #herniatreatment #herniatreatment #ventral hernia hernia,#laparoscopic ventral hernia repair,umbilicus,carl lowe jr,hernia repair,training,north carolina,hernia repair surgery,charlotte,operation,laparoscopic,bulge,surgery,surgeon,dr. lowe,ipom repair,live surgery,mesh,
#mesh #ipom repair
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ThermiVa is a non-surgical vaginal tightening treatment for women who want to reclaim what childbirth or aging may have taken away. Using the same technology that’s used in ThermiTight and ThermiSmooth, radiofrequency energy is sent to the desired area (internally or externally), heating the tissue and stimulating the body’s own collagen. ThermiVa is performed in three treatments over the course of three months.