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Tension pneumothorax describes the progressive accumulation of air in the pleural cavity (normally a potential space) through a defect in the visceral pleura. This leads to positive pressure being maintained and increasing throughout the respiratory cycle causing vessels within the mediastinum to be compressed with catastrophic consequences if left untreated. Clinical signs include hypoxia, hypotension, tachycardia, reduced breath sounds and hyper resonance ipsilaterally, with tracheal deviation (away from the affected side) and distended neck veins being late clinical signs.
Identify the anatomy and explain the physiology of the scrotum on diagrams and sonograms.
Describe and demonstrate the protocol for sonographic scanning of the scrotum.
Identify and describe sonographic images of congenital abnormalities of the scrotum.
Identify and describe sonographic images of pathologies of the scrotum.
Identify and describe sonographic images of extratesticular disease processes.
Identify the anatomy and explain the physiology of the prostate on diagrams and sonograms.
Describe and demonstrate the protocol for transabdominal and endorectal sonographic scanning of the prostate.
Identify and describe sonographic images of benign and malignant pathologies of the prostate, including benign hyperplasia, prostatitis, carcinoma, and calculi.
Explain the technique for prostate biopsy.
Define the criteria for an ultrasound appearance of prostate tumor staging.
Explain the technique for radiation seed implantation.
Explain the Patient Privacy Rule (HIPAA) and Patient Safety Act (see reference).
A breech birth is the birth of a baby from a breech presentation. In the breech presentation the baby enters the birth canal with the buttocks or feet first as opposed to the normal head first presentation.
There are either three or four main categories of breech births, depending upon the source:
* Frank breech - the baby's bottom comes first, and his or her legs are flexed at the hip and extended at the knees (with feet near the ears). 65-70% of breech babies are in the frank breech position.
* Complete breech - the baby's hips and knees are flexed so that the baby is sitting crosslegged, with feet beside the bottom.
* Footling breech - one or both feet come first, with the bottom at a higher position. This is rare at term but relatively common with premature fetuses.
* Kneeling breech - the baby is in a kneeling position, with one or both legs extended at the hips and flexed at the knees. This is extremely rare, and is excluded from many classifications.
As in labour with a baby in a normal head-down position, uterine contractions typically occur at regular intervals and gradually cause the cervix to become thinner and to open. In the more common breech presentations, the baby’s bottom (rather than feet or knees) is what is first to descend through the maternal pelvis and emerge from the vagina.
At the beginning of labour, the baby is generally in an oblique position, facing either the right or left side of the mother's back. As the baby's bottom is the same size in the term baby as the baby's head. Descent is thus as for the presenting fetal head and delay in descent is a cardinal sign of possible problems with the delivery of the head.
In order to begin the birth, internal rotation needs to occur. This happens when the mother's pelvic floor muscles cause the baby to turn so that it can be born with one hip directly in front of the other. At this point the baby is facing one of the mother's inner thighs. Then, the shoulders follow the same path as the hips did. At this time the baby usually turns to face the mother's back. Next occurs external rotation, which is when the shoulders emerge as the baby’s head enters the maternal pelvis. The combination of maternal muscle tone and uterine contractions cause the baby’s head to flex, chin to chest. Then the back of the baby's head emerges and finally the face.
Due to the increased pressure during labour and birth, it is normal for the baby's leading hip to be bruised and genitalia to be swollen. Babies who assumed the frank breech position in utero may continue to hold their legs in this position for some days after birth.
Vaginal prolapse (also called vaginal vault prolapse) is quite common after a hysterectomy (surgery to remove the uterus), but not everyone who has a hysterectomy experiences POP. Without the uterine attachments to hold it up, the top of the vagina can drop into the vaginal canal.
CPAP, or continuous positive airway pressure, is a treatment that uses mild air pressure to keep the airways open. CPAP typically is used by people who have breathing problems, such as sleep apnea. CPAP also may be used to treat preterm infants whose lungs have not fully developed.
The fetal circulation is the circulatory system of a human fetus, often encompassing the entire fetoplacental circulation that also includes the umbilical cord and the blood vessels within the placenta that carry fetal blood.
The fetal circulation works differently from that of born humans, mainly because the lungs are not in use: the fetus obtains oxygen and nutrients from the mother through the placenta and the umbilical cord.
It may be reassuring to know spotting or bleeding after sex is common and can come from the vagina, cervix, or urinary tract. It occurs most commonly in women 20 to 40 years old. Cervical Cancer: A very rare cause of spotting. ... Vaginal Dryness: Often caused by inadequate foreplay or vaginal lubrication.
The Combitube is a twin lumen device designed for use in emergency situations and difficult airways. It can be inserted without the need for visualization into the oropharynx, and usually enters the esophagus. It has a low volume inflatable distal cuff and a much larger proximal cuff designed to occlude the oro- and nasopharynx.
If the tube has entered the trachea, ventilation is achieved through the distal lumen as with a standard ETT. More commonly the device enters the esophagus and ventilation is achieved through multiple proximal apertures situated above the distal cuff. In the latter case the proximal and distal cuffs have to be inflated to prevent air from escaping through the esophagus or back out of the oro- and nasopharynx.
Nosebleeds are common due to the location of the nose on the face, and the large amount of blood vessels in the nose. The most common causes of nosebleeds are drying of the nasal membranes and nose picking (digital trauma), which can be prevented with proper lubrication of the nasal passages and not picking the nose.
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.
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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)
An automated external defibrillator or AED is a portable electronic device that automatically diagnoses the potentially life threatening cardiac arrhythmias of ventricular fibrillation and ventricular tachycardia in a patient,[1] and is able to treat them through defibrillation, the application of electrical therapy which stops the arrhythmia, allowing the heart to reestablish an effective rhythm. The first AED was originally designed and created by American biomedical engineer Joshua L. Koelker and Italian emergency medical professional Jordan M. Blondino to allow defibrillation in common public places. AEDs are designed to be simple to use for the layman, and the use of AEDs is taught in many first aid, first responder, and basic life support (BLS) level CPR classes.
The most reliable clinical sign to detect ascites is checking for bilateral flank dullness. If a patient with ascites is lying supine, fluid accumulates in the flank regions, leading to dullness on percussion. At the same time, the air-filled bowel loops are forced upwards by the free fluid due to buoyancy, resulting in tympanitic percussion. To locate specifically where dullness shifts to tympany, or the air-fluid level, percussion should be performed from the sides towards the middle. To confirm that the dullness is caused by ascites, ask the patient to switch to a lateral decubitus position. If ascites is present, the air-filled bowel loops will shift accordingly and remain at the surface of the fluid. As a result, the air-fluid level will shift as well. This is known as shifting dullness.
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