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http://www.highimpact.com - This brain surgery animation was used to demonstrate a young girl's craniotomy, cranioplasty, and reconstructive skull surgery after her vehicle was struck by a tractor-trailer. The procedures included the evacuation of a large epidural hematoma, the draining of the epidural space, and the reassembly of bone fragments to repair the skull.
More Brain Surgery Animations: https://tinyurl.com/y6m4lkdf
WHAT HAPPENED
A teenage girl was riding home with her parents and boyfriend from a Wednesday night church service when a tractor-trailer struck the back driver’s side of their car as they were traveling through an intersection. The impact sent the car spinning into oncoming traffic where it struck another vehicle. When paramedics arrived, the 17-year-old was unresponsive with bleeding from her left ear and a laceration from behind her left ear.
She was rushed to the hospital where she underwent a series of CT scans that showed a severely comminuted open skull fracture with an underlying 1.1 cm subdural hematoma. She was taken to the operating room where an emergency craniotomy was performed to evacuate the hematoma and reassemble the skull fragments. The patient gradually began to wake up and was discharged six days later, after she showed she could maneuver up and down the hallway.
The biggest challenge in a traumatic brain injury case like this - where most of the damages are deeply underlying and undetectable on the surface - is that the only visual evidence is in the form of 2D black-and-white radiographic films. This can look ambiguous to the typical juror because it’s often difficult to discern where these snapshots are located inside the person’s skull. Tony Seaton, Esq., and Robert Bates, Esq., needed to reinforce this 2D radiographic evidence with maximum 3D context.
We equipped them with a custom Diagnostic Slice Chooser: an interactive presentation that presents radiographic slides within a three-dimensional model of the patient’s head. We also designed the model accurately to the patient’s likeness and colorized the films to highlight key areas of damage. The attorneys could show the complete depth and magnitude of his client’s injuries at every level both before and after the surgery. After establishing the full extent of damages, we also created an animation to walk viewers through the surgical experience the patient would undergo as a result of her injuries.
The visual presentation helped jurors understand the destructive impact this collision had on this young teenager’s life, and Mr. Seaton and Mr. Bates, Esq., were able to acquire a $4.5M settlement for his client.
Read the Full Case Study: https://tinyurl.com/yy4v2dyh
If you use condoms perfectly every single time you have sex, they’re 98% effective at preventing pregnancy. But people aren’t perfect, so in real life condoms are about 85% effective — that means about 15 out of 100 people who use condoms as their only birth control method will get pregnant each year.
Shoulder Clinical Examination - Medical School Clinical Skills - Dr Gill
Personally, I find the shoulder examination the most complex examination possibly as there are so many variations and special tests. Some of which overlap and some will relate specifically to a patients presentation.
Often in a medical school syllabus, only select special tests will be used. In this shoulder exam demonstration, we include the Hawkins-Kennedy Test looking for impingement. This is dovetailed with examination for bicipital tendonitis as this is another possible cause of impingement type symptoms.
This shoulder upper limb exam follows the standard "Look, Feel, Move" orthopaedic exam approach, and overall order as set out in MacLeods Clinical Examination
Watch further orthopaedic examinations for your OSCE revision:
The Spine Examination:
https://youtu.be/pJxMHa6SCgU
Knee Examination
https://youtu.be/oyKH4EYfJDM
Hip Joint Clinical Examination
https://youtu.be/JC9GKq5nSdQ
________
Please note that there is no ABSOLUTE way to perform a clinical examination. Different institutions and even clinicians will have differing degrees of variations - the aim is the effectively identify medically relevant signs.
However during OSCE assessments. Different medical schools, nursing colleges, and other health professional courses will have their own preferred approach to a clinical assessment - you should concentrate on THEIR marks schemes for your assessments.
The examination demonstrated here is derived from Macleods Clinical Examination - a recognized standard textbook for clinical skills.
#ShoulderExamination #ClinicalSkills #DrGill
This video is brought to you by the Stanford Medicine 25 to teach you the common causes of shoulder pain and how to diagnose them by the physical exam.
The Stanford Medicine 25 program for bedside medicine at the Stanford School of Medicine aims to promote the culture of bedside medicine to make current and future clinicians and other healthcare provides better at the art of physical diagnosis and more confident at the bedside of their patients.
Visit us:
Website: http://stanfordmedicine25.stanford.edu/
Blog: http://stanfordmedicine25.stanford.edu/blog.html
Facebook: https://www.facebook.com/StanfordMedicine25
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Diagnoses covered in this video:
Rotator Cuff Pathology
Impingement Syndrome
Biceps Tendinopathy
Adhesive Capsulitis (Frozen Shoulder)
Acromioclavicular (AC) Joint Disease
Shoulder Instability
Labral Tears (SLAP Lesions)
Excerpt from my Normal Skin Histology video: https://kikoxp.com/posts/3660.
A complete organized library of all my videos, digital slides, pics, & sample pathology reports is available here: https://kikoxp.com/posts/5084 (dermpath) & https://kikoxp.com/posts/5083 (bone/soft tissue sarcoma pathology).
Please check out my Soft Tissue Pathology & Dermatopathology survival guide textbooks: http://bit.ly/2Te2haB
Also, in the past I used "keratinocyte" and "squamous cell" interchangeably (this is because in dermatopathology, we see and talk about squamous cell carcinomas all the time, and those tumors are composed of keratinocytes). But technically, in normal skin histology, "squamous cell" refers only to the flattened keratinocytes in the superficial epidermis. Thankfully, a histology PhD colleague pointed this out to me and corrected my lazy nomenclature!
This video is geared towards medical students, pathology or dermatology residents, or practicing pathologists or dermatologists. Of course, this video is for educational purposes only and is not formal medical advice or consultation.
Presented by Jerad M. Gardner, MD. Please subscribe to my channel to be notified of new pathology teaching videos.
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An abscess is a collection of pus. Pus is a thick fluid that usually contains white blood cells, dead tissue and germs (bacteria). The usual cause of an abscess is an infection with bacteria. Certain bacteria are more likely to be 'pus-forming' as they make chemicals (toxins) that can damage the body's tissues.
Debridement is the removal of necrotic tissue, foreign debris, bacterial growth, callus, wound edge, and wound bed tissue from chronic wounds in order to stimulate the wound healing process. Stimulation of wound healing mediated by debridement is thought to occur by the conversion of a chronic non-healing wound environment to an acute healing environment through the removal of cells that are not responsive to endogenous healing stimuli. Debridement is used commonly in standard wound treatment of diabetic foot ulcers (DFUs). Methods of debridement include surgery (sharp debridement), chemical debridement (antiseptics, polysaccharide beads, pastes), autolytic (hydrogels, hydrocolloids and transparent films), biosurgery (maggots), mechanical (hydrodebridement), and biochemical debridement (enzyme preparations). Callus is a buildup of keratinized skin formed under conditions of repeated pressure or friction and may contribute to ulcer formation by creating focal areas of high plantar pressure. The debridement of callus has been proposed to be relevant for both treatment and prevention of DFU. The purpose of this report is to retrieve and review existing evidence of comparative clinical effectiveness of different methods of debridement for the treatment of DFUs. Additionally examined in this report is the clinical effectiveness for treatment and prevention of DFU using callus debridement. Cost-effectiveness, and existing debridement guidelines for the treatment of DFUs will also be reviewed.
Given the success of drugs to treat erectile dysfunction, such as sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra), drug companies have sought a comparable drug for women. Viagra has even been tried as a treatment for sexual dysfunction in women. However, the Food and Drug Administration (FDA) hasn't approved this use of Viagra. Indeed, until recently there were no FDA-approved drugs for treating sexual arousal or sexual desire problems in women. Yet 4 in 10 women report having sexual concerns. A prescription medication known as flibanserin (Addyi) — originally developed as an antidepressant — has been approved by the FDA as a treatment for low sexual desire in premenopausal women. A daily pill, Addyi may boost sex drive in women with low sexual desire and who find the experience distressing. Potentially serious side effects include low blood pressure, dizziness and fainting, particularly if the drug is mixed with alcohol. Experts recommend that you stop taking the drug if you don't notice an improvement in your sex drive after eight weeks.
Detailed examination of the joints is usually not included in the routine medical examination. However, joint related complaints are rather common, and understanding anatomy and physiology of both normal function and pathologic conditions is critically important when evaluating the symptomatic patient. By gaining an appreciation for the basic structures and functioning of the joint, you'll be able to "logic" your way thru the exam, even if you can't remember the eponym attached to each specific test!
A peritonsillar abscess forms in the tissues of the throat next to one of the tonsils. An abscess is a collection of pus that forms near an area of infected skin or other soft tissue. The abscess can cause pain, swelling, and, if severe, blockage of the throat. If the throat is blocked, swallowing, speaking, and even breathing become difficult. When an infection of the tonsils (known as tonsillitis) spreads and causes infection in the soft tissues, a peritonsillar abscess may result. Peritonsillar abscesses are generally uncommon. When they do occur they are more likely among young adults, adolescents, and older children.
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.