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MRCPCH Clinical Revision - more videos at http://mrcpch.paediatrics.co.uk
Revise for your MRCPCH Clinical exam, with videos and high quality content created by the London Paediatrics Trainees Committee.
Video Credits: Dr Caroline Fertleman, Dr Hermione Race, Dr Camilla Sen, Dr Chloe Macaulay, Dr Emma McLaren, Chris Knapp
A pneumothorax is usually caused by an injury to the chest, such as a broken rib or puncture wound. It may also occur suddenly without an injury. A pneumothorax can result from damage to the lungs caused by conditions such as chronic obstructive pulmonary disease (COPD), asthma, cystic fibrosis, and pneumonia.
Learn Basic Laparoscopic Surgery, the components of a laparoscopic surgical setup, optimal positioning and ergonomics in laparoscopic surgery, and much more. Check out the full course for free here: https://www.incision.care/free-trial
What is Laparoscopic Surgery:
Laparoscopic surgery describes procedures performed using one or multiple small incisions in the abdominal wall in contrast to the larger, normally singular incision of laparotomy. The technique is based around principles of minimally invasive surgery (or minimal access surgery): a large group of modern surgical procedures carried out by entering the body with the smallest possible damage to tissues. In abdominopelvic surgery, minimally invasive surgery is generally treated as synonymous with laparoscopic surgery as are procedures not technically within the peritoneal cavity, such as totally extraperitoneal hernia repair, or extending beyond the abdomen, such as thoraco-laparoscopic esophagectomy. The term laparoscopy is sometimes used interchangeably, although this is often reserved to describe a visual examination of the peritoneal cavity or the purely scopic component of a laparoscopic procedure. The colloquial keyhole surgery is common in non-medical usage.
Surgical Objective of Laparoscopic Surgery:
The objective of a laparoscopic approach is to minimize surgical trauma when operating on abdominal or pelvic structures. When correctly indicated and performed, this can result in smaller scars, reduced postoperative morbidity, shorter inpatient durations, and a faster return to normal activity. For a number of abdominopelvic procedures, a laparoscopic approach is now generally considered to be the gold-standard treatment option.
Definitions
Developments of Laparoscopic Surgery:
Following a number of smaller-scale applications of minimally invasive techniques to abdominopelvic surgery, laparoscopic surgery became a major part of general surgical practice with the introduction of laparoscopic cholecystectomy in the 1980s and the subsequent pioneering of endoscopic camera technology. This led to the widespread adoption of the technique by the early- to mid-1990s. The portfolio of procedures that can be performed laparoscopically has rapidly expanded with improvements in instruments, imaging, techniques and training — forming a central component of modern surgical practice and cross-specialty curricula [2]. Techniques such as laparoscopically assisted surgery and hand-assisted laparoscopic surgery have allowed the application of laparoscopic techniques to a greater variety of pathology. Single-incision laparoscopic surgery, natural orifice transluminal endoscopic surgery, and minilaparoscopy-assisted natural orifice surgery continue to push forward the applications of minimally invasive abdominopelvic techniques; however, the widespread practice and specific indications for these remain to be fully established. More recently, robotic surgery has been able to build on laparoscopic principles through developments in visualization, ergonomics, and instrumentation.
This Basic Laparoscopic Surgery Course Will Teach You:
- Abdominal access techniques and the different ways of establishing a pneumoperitoneum
- Principles of port placement and organization of the operative field
- Key elements of laparoscopic suturing, basic knotting and clip application
Specific attention is paid to the following hazards you may encounter:
- Fire hazard and thermal injury
- Lens fogging
- Contamination of insufflation system
- Complications from trocar introduction
- Limitations of Veress needle technique
- Limitations of open introduction technique
- Complications of the pneumoperitoneum
- Gas embolism
- Mirroring and scaling of instrument movements
- Firing clip applier without a loaded clip
The following tips are designed to improve your understanding and performance:
- Anatomy of a laparoscope
- Checking for optic fiber damage
- "White balance" of camera
- Checking integrity of electrosurgical insulation
- Access at Palmer's point
- Lifting abdominal wall before introduction
- Confirming position of Veress needle
- Umbilical anatomy
- Identification of inferior epigastric vessels under direct vision
- Translumination of superficial epigastric vessels
- Selection of trocar size
- Aiming of trocar
- Working angles in laparoscopic surgery
- Choice of suture material
- Instruments for suturing
- Optimal ergonomics for suturing
- Extracorporeal needle positioning
- Optimal suture lengths
- "Backloading" needle
- Intracorporeal needle positioning
- Hand movements when suturing
- Optimal positioning of scissors
- Extracorporeal knot tying
- Visualization of clip applier around target structure
- Common clip configurations
Austin lip augmentation at Aesthetica MedSpa is a quick, out patient procedure that will create a more youthful looking face. Dr. Sneed uses restylane and juvederm to plump up your lips. He may recommend combing this lip enhancement procedure with injections of radiesse to re volumize your facial features. To learn more about this procedure, visit http://www.amedspa.com/austin-lip-injections.php.
Identify the anatomy and explain the physiology of the breast on diagrams and sonograms.
Describe and demonstrate the protocol for sonographic scanning of the breast, including the clock and quadrant methods, and targeted examinations based on mammographic findings.
Describe the various diagnostic pathways that may lead to a sonographic breast examination, and explain how the ultrasound findings are correlated with other imaging modalities.
Identify and describe sonographic images of benign and malignant features and common breast pathologies.
Explain biopsy techniques for breast tumors.
Define and use related medical terminology.
Explain the Patient Privacy Rule (HIPAA) and Patient Safety Act (see reference
A brain surgery called a craniectomy is performed to remove a part of your skull in order to relieve pressure in an area when your brain swells from a traumatic brain injury. It is also performed to treat medical conditions that cause your brain to swell or bleed that can be caused by an aneurysm, brain tumor or other cancer.
This 3d animation shows how the surgical procedure decreases intracranial pressure (ICP), intracranial hypertension (ICHT), or heavy bleeding (also called hemorrhaging) inside your skull. If left untreated, pressure or bleeding can compress your brain and push it down onto the brain stem. This can be fatal or cause permanent brain damage.
Brain surgery is a very serious procedure under any circumstances, but a craniectomy is done when there is an immediate risk to the brain and neurological function due to severe brain injury or stroke.
For more information about custom 3D animation depicting surgery, please visit https://www.amerra.com/.
Watch additional medical animations:
Accessing an implantable port training - 3D animation: https://youtu.be/xSTpxjyv4O4
Open Suctioning with a Tracheostomy Tube - 3D animation: https://youtu.be/wamB7jpWCiQ
Ventriculostomy Brain Surgery - 3d animation: https://youtu.be/pUy0YDzVNzs
Suctioning the endotracheal tube - medical animation: https://youtu.be/pN6-EYoeh3g
Functional endoscopic sinus surgery (FESS) - 3D animation: https://youtu.be/qKTRyowwaLA
How to insert a nasogastric tube for NG intubation - 3d animation: https://youtu.be/Abf3Gd6AaZQ
Oral airway insertion - oropharyngeal airway technique - 3D animation: https://youtu.be/caxUdNwjt34
Nasotracheal suctioning (NTS) - 3D animation: https://youtu.be/979jWMsF62c
Learn about hemorrhoids with #3d #animation: https://youtu.be/R6NqlMpsiiY
LASIK eye surgery - 3D animation: https://youtu.be/Bb8bnjnEM00
CPR cardiopulmonary resuscitation - 3D animation: https://youtu.be/G87knTZnhks
What are warts (HPV)? - 3D animation: https://youtu.be/guJ1J7rRs1w
How Macular Degeneration Affects Your Vision - 3D animation: https://youtu.be/ozZQIZ_52YY
NeoGraft hair transplant procedure – animation: https://youtu.be/C-eTdH2UPXI
This Basic Laparoscopic Surgery: Abdominal Access and Trocar Introduction course will teach you the steps of Laparoscopic Surgery. View the full course for free by signing up on our website: https://www.incision.care/
What is Laparoscopic Surgery:
Laparoscopic surgery describes procedures performed using one or multiple small incisions in the abdominal wall in contrast to the larger, normally singular incision of laparotomy. The technique is based around principles of minimally invasive surgery (or minimal access surgery): a large group of modern surgical procedures carried out by entering the body with the smallest possible damage to tissues. In abdominopelvic surgery, minimally invasive surgery is generally treated as synonymous with laparoscopic surgery as are procedures not technically within the peritoneal cavity, such as totally extraperitoneal hernia repair, or extending beyond the abdomen, such as thoraco-laparoscopic esophagectomy. The term laparoscopy is sometimes used interchangeably, although this is often reserved to describe a visual examination of the peritoneal cavity or the purely scopic component of a laparoscopic procedure. The colloquial keyhole surgery is common in non-medical usage.
Surgical Objective of Laparoscopic Surgery:
The objective of a laparoscopic approach is to minimize surgical trauma when operating on abdominal or pelvic structures. When correctly indicated and performed, this can result in smaller scars, reduced postoperative morbidity, shorter inpatient durations, and a faster return to normal activity. For a number of abdominopelvic procedures, a laparoscopic approach is now generally considered to be the gold-standard treatment option.
Definitions
Developments of Laparoscopic Surgery:
Following a number of smaller-scale applications of minimally invasive techniques to abdominopelvic surgery, laparoscopic surgery became a major part of general surgical practice with the introduction of laparoscopic cholecystectomy in the 1980s and the subsequent pioneering of endoscopic camera technology. This led to the widespread adoption of the technique by the early- to mid-1990s. The portfolio of procedures that can be performed laparoscopically has rapidly expanded with improvements in instruments, imaging, techniques and training — forming a central component of modern surgical practice and cross-specialty curricula [2]. Techniques such as laparoscopically assisted surgery and hand-assisted laparoscopic surgery have allowed the application of laparoscopic techniques to a greater variety of pathology. Single-incision laparoscopic surgery, natural orifice transluminal endoscopic surgery, and minilaparoscopy-assisted natural orifice surgery continue to push forward the applications of minimally invasive abdominopelvic techniques; however, the widespread practice and specific indications for these remain to be fully established. More recently, robotic surgery has been able to build on laparoscopic principles through developments in visualization, ergonomics, and instrumentation.
This Basic Laparoscopic Surgery: Abdominal Access and Trocar Introduction course will teach you:
- How to access the abdomen using an open, closed, and direct optical-entry technique
- Principles underlying safe abdominal insufflation
- The vascular anatomy of the abdominal wall and its implications for trocar placement
- How to introduce trocars into the peritoneal cavity
- The principle of triangulation and how this can be applied to organizing a laparoscopic surgical field
Specific attention is given to these hazards you may encounter:
- Intravascular, intraluminal, or extraperitoneal needle position
- Limitations of a closed introduction technique
- Abdominal surgical history
- Limitations of an open introduction technique
- Optical trocar entry in thin individuals
- Visualization of non-midline structures
- Limitations of direct optical-entry techniques
- Limitations of clinical examination to confirm intraperitoneal insufflation
- Leakage of insufflation gas
These tips are designed to help you improve your understanding and performance:
- Alternative left upper quadrant approach
- Testing Veress needle before use
- Lifting the abdominal wall for Veress needle introduction
- "Hanging-drop test"
- Palmer's test
- Confirming intra-abdominal insufflation
- Subcutaneous tissue retraction
- Anatomy of the umbilicus
- Retraction of abdominal wall fascia
- Finger sweep of anterior abdominal wall
- Lifting the abdominal wall for optical trocar introduction
- Identification of venous bleeding at the end of a procedure
- Identification of inferior epigastric vessels by direct vision
- Peritoneal folds of the anterior abdominal wall
- Transillumination of superficial epigastric vessels
- Infiltration of local anesthetic at port sites
- Aiming of trocars
- Selection of trocar size
- Maintaining direct vision
For more videos, please visit:
http://surgicalfilmatlas.mssm.edu/
Uterine polyps are growths attached to the inner wall of the uterus that extend into the uterine cavity. Overgrowth of cells in the lining of the uterus (endometrium) leads to the formation of uterine polyps, also known as endometrial polyps. These polyps are usually noncancerous (benign), although some can be cancerous or can eventually turn into cancer (precancerous polyps). Uterine polyps range in size from a few millimeters — no larger than a sesame seed — to several centimeters — golf-ball-size or larger. They attach to the uterine wall by a large base or a thin stalk.
In this animation it depicts an artery with cholesterol plaque (the yellowish area) which is blocking most of the inside of this artery. Then small cells called platelets become clumped together and cause the red blood cells to form a clot. This is what causes a HEART ATTACK.
The vast majority of glucocorticoid activity in most mammals is from cortisol, also known as hydrocortisone. Corticosterone, the major glucocorticoid in rodents, is another glucocorticoid. Cortisol binds to the glucocorticoid receptor in the cytoplasm and the hormone-receptor complex is then translocated into the nucleus, where it binds to its DNA response element and modulates transcription from a battery of genes, leading to changes in the cell's phenotype. Only about 10% of circulating cortisol is free. The remaining majority circulates bound to plasma proteins, particularly corticosteroid-binding globulin (transcortin). This protein binding likely decreases the metabolic clearance rate of glucocorticoids and, because the bound steroid is not biologically active, tends to act as a buffer and blunt wild fluctuations in cortisol concentration.