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Cancer Patient Dances in OR before her Surgery

If you're pregnant, you're likely paying extra close attention to your body. If you happen to feel a cramp you may worry that it is a sign of a miscarriage. While the first trimester is the most common time for miscarriages, there are other reasons for cramps. Whether it signals a miscarriage depends on when it occurs, the severity of the cramping, and whether you're experiencing other symptoms alongside it.

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Stoma Care- Changing a Colostomy Bag (Nursing Skills)

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05.01 Stoma Care (Colostomy bag) | NURSING.com

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Stoma Care- Changing a Colostomy Bag (Nursing Skills)

In this video, we’re going to talk about stoma care. Now, the wafer and bag for an ostomy only NEEDS to be changed every 3 days, or if it’s leaking. But, you still need to be able to assess the stoma itself. In this case we’re going to show you how to replace the bag and clean and assess the stoma. Start by putting a towel under the patient on the side of the stoma. We love you guys! Go out and be your best selves today! And, as always, happy nursing!

Bookmarks:
0.05 Introduction to Stoma Care
0:20 Assessing the stoma
0:47 Cleaning the stoma
1:12 Inspecting the stoma
1:25 Measuring and cutting the stoma
2:00 Applying and sealing the bag
2:35 Documentation
2:41 Outro

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What is Venipuncture? While venipuncture can refer to a variety of procedures, including the insertion of IV tubes into a vein for the direct application of medicine to the blood stream, in phlebotomy venipuncture refers primarily to using a needle to create a blood evacuation point. As a phlebotomist, you must be prepared to perform venipuncture procedures on adults, children, and even infants while maintaining a supportive demeanor and procedural accuracy. Using a variety of blood extraction tools, you must be prepared to respond to numerous complications in order to minimize the risk to the patient while still drawing a clean sample. In its entirety, venipuncture includes every step in a blood draw procedure—from patient identification to puncturing the vein to labeling the sample. Patient information, needle placement, and emotional environment all play a part in the collection of a blood sample, and it's the fine details that can mean the difference between a definite result and a false positive. After placing the tourniquet and finding the vein, it's time for the phlebotomist to make the complex choice on what procedure will best suit the specific situation. Keeping this in mind, it should be noted that the following information is not an instructional guide on how to perform these phlebotomy procedures. Rather, the information below is intended to serve as an educational resource to inform you of the equipment and procedures you will use. Venipuncture Technqiues Venipuncture with an Evacuated or Vacuum Tube: This is the standard procedure for venipuncture testing. Using a needle and sheath system, this procedure allows multiple sample tubes to be filled through a single puncture. This procedure is ideal for reducing trauma to patients. After drawing the blood, the phlebotomist must make sure the test stopper is correctly coded and doesn't contact exposed blood between samples. Venipuncture with a Butterfly Needle : This is a specialized procedure that utilizes a flexible, butterfly needle adaptor. A butterfly needle has two plastic wings (one on either side of the needle) and is connected to a flexible tube, which is then attached to a reservoir for the blood. Due to the small gauge of the needle and the flexibility of the tube, this procedure is used most often in pediatric care, where the patients tend to have smaller veins and are more likely to move around during the procedure. After being inserted into a vein at a shallow angle, the butterfly needle is held in place by the wings, which allow the phlebotomist to grasp the needle very close to the skin. Phlebotomists should be careful to watch for blood clots in the flexible tubing. Venipuncture with a Syringe: This technique is typically only used when there is a supply shortage, or when a technician thinks it is the appropriate method. It uses the classic needle, tube, and plunger system, operating in a similar manner to the vacuum tube but requiring multiple punctures for multiple samples. Additionally, after the blood is drawn it must be transferred to the appropriate vacuum tube for testing purposes. If you choose to use this method, remember to check for a sterile seal, and use a safety device when transferring the sample. Fingerstick (or Fingerprick): This procedure uses a medical lance to make a small incision in the upper capillaries of a patient's finger in order to collect a tiny blood sample. It is typically used to test glucose and insulin levels. When performing a Fingerstick, the phlebotomist should remember to lance the third or fourth finger on the non-dominant arm. Never lance the tip or the center of the finger pad; instead, lance perpendicular to the fingerprint lines. Heelstick (or Heelprick): Similar to the Fingerstick procedure, this process is used on infants under six months of age. A medical lance is used to create a small incision on the side of an infant's heel in order to collect small amounts of blood for screening. As with a Fingerstick, the incision should be made perpendicular to the heel lines, and it should be made far enough to the left or right side of the heel to avoid patient agitation. Before performing a Heelstick, the infant's heel should be warmed to about 42 degrees Celsius in order to stimulate capillary blood and gas flow. Therapeutic Phlebotomy: This involves the actual letting of blood in order to relieve chemical and pressure imbalances within the blood stream. Making use of a butterfly needle, this therapy provides a slow removal of up to one pint of blood. Though the blood removed is not used for blood transfusions, the procedure and concerns are the same as with routine blood donation. As with any phlebotomy procedure, one should pay close attention to the patient in order to prevent a blood overdraw. Bleeding Time: A simple diagnostic test that is used to determine abnormalities in blood clotting and platelet production. A shallow laceration is made, followed by sterile swabbing of the wound every 30 seconds until the bleeding stops. Average bleed times range between one and nine minutes. As a phlebotomist, you should familiarize yourself with the application and cross-application of these procedures in order to recognize when a procedure is necessary, and what the risks are for each.

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The headache, lethargy, and neck stiffness suggest subarachnoid hemorrhage secondary to rupture of a mycotic aneurysm. Mycotic or infected arterial aneurysms can develop due to metastatic infection from IE, with septic embolization and localized vessel wall destruction in the cerebral (or systemic) circulation. Intracerebral mycotic aneurysms can present as an expanding mass with focal neurologic findings or may not be apparent until aneurysm rupture with stroke or subarachnoid hemorrhage. The diagnosis of mycotic cerebral aneurysm can usually be confirmed with computed tomography angiography. Management includes broad-spectrum antibiotics (tailored to blood culture results) and surgical intervention (open or endovascular).

This video documents the experience of one of our Mommy Makeover patients. She is 39 years old, 5’4” tall, and of average weight. Following the birth of her twins, she wanted to improve her abdominal wall contour and correct the lack of shape and firmness in her breasts.

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Train with some of the region’s very best pediatric general surgeons — in a two-year, pediatric surgical fellowship training program at Nemours/Alfred I. duPont Hospital for Children. Our hospital’s Division of Pediatric Surgery is offering this program in affiliation with Sidney Kimmel Medical College at Thomas Jefferson University .

The goal of the fellowship is to give individuals who have completed an accredited general surgery residency advanced knowledge and training in the management and surgical treatment of newborns, infants and children.

Our Fellowship Program
This fellowship will help you prepare for certification by the American Board of Surgery, and is accredited by the Accreditation Council for Graduate Medical Education (ACGME).

The Pediatric Surgery Fellowship aims to:

train a well-rounded, empathetic, safe pediatric surgeon who is confident managing all aspects of the surgical care of children.
steward our fellow in quality improvement projects and methodology, and provide research opportunities.
provide a rigorous didactic curriculum for our fellow utilizing 360 degree feedback.
cultivate opportunities for our fellow to educate residents and students.
encourage our fellow to collaborate across specialties.
develop our fellow’s presentation skills during M&M conferences and multi-disciplinary educational meetings.
The program features the full participation of all nine of the pediatric surgical division’s full-time faculty members. Each of these physicians will contribute greatly to your education. Your training will include operating room and outpatient clinic experience, as well as bedside evaluation of children. You’ll also play a role in the organization of formal teaching conferences, held weekly. Formal rotations will be spent on Pediatric Urology, PICU and Neonatology during the first 12 months. The last year will be spent entirely on the Pediatric Surgical Service.
The majority of your inpatient consultative time will take place at Nemours/Alfred I. duPont Hospital for Children, a freestanding children’s hospital in Wilmington, Del. The hospital:

is nationally ranked by U.S. News & World Report in eight pediatric specialties
recently opened expansion with 260 beds
performs more than 2,800 inpatient and 9,300 outpatient surgical procedures each year in our operating rooms
has an on-site delivery center for newborns with complex congenital anomalies
receives more than 50,000 annual visits in our Emergency Department (ED)
is accredited by The American College of Surgeons as a Level One Pediatric Trauma Center
is accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF)


Visit https://www.nemours.org/educat....ion/gme/fellowships/ to learn more.

Elbow Exam - Orthopaedic OSCE - Clinical Skills - Dr Gill

The elbow examination is a core skill - in this video, we demonstrate how to perform an elbow EXAM for an Orthopaedic Clinical Skills OSCE, which should be one of the more accessible examination stations for medical students.

For a passing grade in your Clinical Skills OSCE, an elbow assessment should follow the LOOK, FEEL, MOVE approach

Initially looking for erythema, scars, swelling and position

Palpating the elbow - specifically the olecranon, medial and lateral epicondyles, and radial head for heat, oedema and crepitus

Finally assess range of movement with flexion and extension at the elbow, before determining for tennis and golfers' elbows

Watch further orthopaedic examinations for your OSCE revision:

The Elbow - Deep Dive
https://youtu.be/SX5buhtCVDw

The Spine Examination:
https://youtu.be/pJxMHa6SCgU

The Knee examination
https://youtu.be/oyKH4EYfJDM

The Hip examination
https://youtu.be/JC9GKq5nSdQ

The GALS examination
https://youtu.be/5qJaf7gW-B0 - Gait, Arms, Legs, Spine - GALS screen

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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 recognised standard textbook for clinical skills.

Some people viewing this medical examination video may experience an ASMR effect

#clinicalskills #Elbow #DrGill

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Asbestosis is linked to chrysotile fibers. Chrysotile is one of the six known types of asbestos. Exposure occurs when someone breathes in the dangerous fibers. Extended exposure can lead to an accumulation of the fibers in lung tissues, setting the stage for long-term fibrosis (scarring). Over time, lung tissues thicken, causing pain and restricting breathing. Symptoms include labored breathing during routine tasks and exercise, chest pain and coughing. Doctors prescribe breathing treatments, prescription medication and sometimes surgery for people with asbestosis.