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This poor old lady came with swelling in her left buttock for 10 days.She had history of injection in her buttocks two weeks back. She developed painful swelling and redness in her left gluteal region with difficulty in walking.It was diagnosed as injection abscess left gluteal region which needs incision and drainage under local anesthesia.Patient part painted and drapped.2% Lignocaine with adrenaline was infiltrated around the swelling for proper filed block.I use no-11 blade for stab incision over the swelling at the most fluctuating point of the abscess.You can watch how pus was flowing out from the cavity.The aim is to drain all pus from the abscess cavity.Finger exploration is essential to break all loculi inside the cavity, to know the depth and extend of the cavity and to fascilitate proper drainage of residual pus.after pus evacuation,, the cavity should be irrigated with normal saline and betadine solution.lastly the cavity to be packed with betadine soaked guage pieces.Proper dressing is essential.the dressing to be changed after 24 hours.daily dressing is essential with a good antibiotic coverage.the cavity usually obliterates within a period of seven to ten days.
Doctor Ricky Brown reacts to this surgery simulation of an inguinal hernia repair where they repair the hernia sack and create a mesh for the organ to comfortably rest on.
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A silent heart attack is a heart attack that has few, if any, symptoms. You may have never had any symptoms to warn you that you've developed a heart problem, such as chest pain or shortness of breath. Having diabetes or prediabetes puts you at increased risk for heart disease and stroke. You can lower your risk by keeping your blood glucose (also called blood sugar), blood pressure, and blood cholesterol close to the recommended target numbersthe levels suggested by diabetes experts for good health. (
Cervical cancer occurs when abnormal cells on the cervix camera.gif grow out of control. The cervix is the lower part of the uterus that opens into the vagina. Cervical cancer can often be successfully treated when it's found early. It is usually found at a very early stage through a Pap test.
The head-to-toe assessment in nursing is an important physical health assessment that you'll be performing as a nursing student and nurse.
Head-to-toe assessments allow nurses to assess the health status of patients by following a checklist of criteria.
On the job, your head-to-toe nursing assessment will be performed much faster, and it may be different or more specialized to accommodate the patients' needs within your nursing specialty.
This assessment represents a general assessment checklist (or cheat sheet) that you might encounter in nursing school. (Note: Always follow your instructor's requirements or your employer's assessment protocols).
This nursing head-to-toe examination video guide will focus on the following areas/skills:
-Vital Signs (pulse rate, respiration rate, temperature, oxygen saturation, blood pressure, pain assessment)
https://www.youtube.com/watch?v=gUWJ-6nL5-8
-Cranial Nerve examination
-Head assessment (hair, cranium, eyes, nose, mouth, ears, sinuses)
-Neck assessment (jugular vein, thyroid, trachea, carotid)
-Heart sounds assessment: https://www.youtube.com/watch?v=H48WsyIjFs0&t=73s
-Lung sounds assessment: https://www.youtube.com/watch?v=KNrcG077brQ
-Abdominal assessment
-Assessing extremities (arms, hands, legs, feet)
-Back assessment
-and more
While performing your comprehensive head-to-toe assessment, you'll want to record your findings in the documentation.
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Scoliosis is a sideways curvature of the spine that occurs most often during the growth spurt just before puberty. While scoliosis can be caused by conditions such as cerebral palsy and muscular dystrophy, the cause of most scoliosis is unknown. Most cases of scoliosis are mild, but some children develop spine deformities that continue to get more severe as they grow. Severe scoliosis can be disabling. An especially severe spinal curve can reduce the amount of space within the chest, making it difficult for the lungs to function properly. Children who have mild scoliosis are monitored closely, usually with X-rays, to see if the curve is getting worse. In many cases, no treatment is necessary. Some children will need to wear a brace to stop the curve from worsening. Others may need surgery to keep the scoliosis from worsening and to straighten severe cases of scoliosis.
We herein describe endoscopic treatment of symptomatic pancreatic pseudocyst with significant necrosis and a fistula. Fifty eight year old man had presented to us with a large pseudocyst following an episode of acute pancreatitis. He was complaining of significant abdominal pain for two months. A... CT scan abdominal had revealed a large retro-gastric pseudocyst with necrosis and portal venous thrombosis. An upper GI endoscopy had revealed small linear fundal varcies. Endoscopic as well as surgical treatment for the cyst was discussed with the patient. Patient wished not to undergo surgical treatment and therefore endoscopic treatment was selected after a proper consent. EUS was performed to see for the interposed vessel prior to the pseudocyst puncture. Needle knife puncture was made and a guide wire was passed in the pseudocyst cavity. After confirming the wire placement in the cyst, the tract was dilated up to 20 mms using a CRE balloon. Fluid from the cyst was emptied out in the stomach. An ERCP scope was passed in to the cyst cavity, which revealed a significant necrotic material (much more than what the CT scan had revealed). All the free lying necrotic material was taken out with the help of a snare and a dormia basket. A lot of necrotic was stuck to the cyst wall, which was removed with the help of water jet, mechanical scooping and cutting through using a needle knife papillotome. Three 10 fr. Pigtail stents were placed at the end of the procedure. Further necrosectomy was carried out on alternate days for three more sessions. Dilation was required prior to each session three pigtail trans-gastric stents were placed at the end of each session. Single stent was kept in situ during each procedure to guide the path (the position of the stoma changed dramatically once the cyst was empty). During the last lesion (session four), a pancreatogram was taken. It revealed a mildly dilated CBD in the head, normally duct in the proximal body with a leak from the distal body, and contrast was seen going in to the pseudocyst cavity. The duct could not be opacified distally. A 7 fr. 15 cms stent was placed trans-papillary. When the cyst cavity was reentered through trans-gastric route, the trans-papillary pancreatic stent was clearly visible with soft necrotic material around it. In fact, the stent guided further necrosis removal. It also helped in diverting the pancreatic juice to the duodenum rather than in the pseudocyst cavity. Patient was discharged after this session and was followed up regularly. A CT scan was obtained after three months, which revealed a complete resolution of the necrosis and pseudocyst. There was a possibility of a persistent fistula after the removal of trans-papillary stent and a recurrence of the pseudocyst. Fistula closure with cyanoacrylate glue is well described in the literature. The procedure can have obvious complications secondary to accidental blockage of the main pancreatic duct. So, we thought it prudent to use a safer alternative to treat the condition. We removed the longer pancreatic stent and replaced it with a shorter pancreatic stent occupying only the head region. The patient was followed up after a month; sonography of the abdomen did not reveal any recurrence of the pseudocyst. All the stents were removed at this examination.
Rectal bleeding can refer to any blood that passes from your anus, although rectal bleeding is usually assumed to refer to bleeding from your lower colon or rectum. Your rectum makes up the last few inches of your large intestine. Rectal bleeding may show up as blood in your stool, on the toilet paper or in the toilet bowl. Blood that results from rectal bleeding can range in color from bright red to dark maroon to a dark, tarry color.
Colonoscopy is a test that allows your doctor to look at the inner lining of your large intestine (rectum and colon). He or she uses a thin, flexible tube called a colonoscope to look at the colon. A colonoscopy helps find ulcers, colon polyps, tumors, and areas of inflammation or bleeding.
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This hour long medical exam has a quiet doctor performing a routine medical exam with minimal talking. The video is 100% accidental ASMR and features a real doctor doing a head to toe assessment. This is honestly one of the best medical exam ASMR videos and on my all time favourite unintentional ASMR videos. This audio for this video has been significantly edited for maximum ASMR.
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Cisplatin is in a class of drugs known as platinum-containing compounds used to treat various types of cancers including metastatic testicular and ovarian tumors. The molecule was first discovered in 1845, but did not receive FDA approval until 1978. Today it is known as the "penicillin of cancer drugs," because it is so effective for many different cancers. There are three key players involved in Cisplatin's mechanism: (1) Cisplatin, (2) DNA (3) and an HMG Protein. Most Cisplatin enters the body through active transport, but some molecules are passively defused through the cell membrane. Once in the nucleus, Cisplatin can form an adduct with two consecutive guanine bases within a strand of DNA. The molecule loses its chlorine atoms in exchange for the nitrogen atoms of the target guanines. Cisplatin can bond more tightly with nitrogen because nitrogen balances the platinum charge more effectively than chlorine. It is this adduct-induced DNA bend that allows binding of proteins which contain the high mobility group, HMG domain. Once the protein is bound to the DNA, it inserts a wedge-like phenyl group of phenylalanine 37 into the widened minor groove created by the bend. The tightly bound HMG protein causes destacking of the nucleotide bases, resulting in the DNA helix becoming kinked. In this way, Cisplatin can be thought of as a monkey wrench in the DNA repair system. With the HMG protein bound to the DNA, the modified strand is not repaired properly and so the cell dies. The success of Cisplatin depends on its ratio of efficacy between cancerous and healthy cells.
There are a number of different causes of vertigo. Vertigo can be defined based upon whether the cause is peripheral or central. Central causes of vertigo arise in the brain or spinal cord while peripheral vertigo is due to a problem within the inner ear. The inner ear can become inflamed because of illness, or small crystals or stones found normally within the inner ear can become displaced and cause irritation to the small hair cells within the semicircular canals, leading to vertigo. This is known as benign paroxysmal positional vertigo (BPPV).
CMV is a common virus in the same family as herpesvirus, and it can infect anyone. CMV is spread by direct contact of body fluids, such as saliva, blood, urine, semen, vaginal fluids, and breast milk. Thus breastfeeding, blood transfusions, organ transplants, and sexual contact are possible modes of transmission. Most healthy people do not experience any symptoms when infected with CMV, and it does not pose a serious health concern. A majority of adults have antibodies consistent with past infection. Most healthy children and adults who do have symptoms will recover from CMV infection without complications and do not require antiviral treatment. However, in those with a weakened immune system, CMV can cause serious disease (retinitis, hepatitis, colitis, pneumonia, or encephalitis).
Pancreatic pseudocyst drainage was the first therapeutic application of EUS. The cyst is punctured under ultrasound guidance, contrast injected, and a guidewire inserted. Initial dilation to 8mm is performed over the wire The EUS scope is then exchanged over the wire for a forward viewing endoscope.... A second dilation to 18mm is performed. This enables entry of the endoscope into the cyst perform cystoscopy, debridement if necessary, and insertion of multiple large bore double pigtail stents. The curved linear array-or CLA—echoendoscope has oblique viewing optics located proximal to an oblique scanning transducer. The accessory exits from the shaft of the echoendoscope at an ablique angle, adjustable between 15 and 30 degrees. There are several technical limitations using this echoendoscope. The oblique angle of exit results in a weekend transfer of force when advancing the accessory, difficult deployment of larger bore accessories, and in instrument tunneling effect relative to the bowel wall. There is the potential loss of access during endoscope exchange. A novel CLA echoendoscope was developed by the Olympus Corporation that shifts the orientation of endoscopic and ultrasound views from oblique to forward viewing. The channel is therapeutic at 3.7mm Note that the working channel is located adjacent to the ultrasound transducer at the endoscope tip. The accessory exits the working channel in the axis of the shaft. Shown here are balloon inflation and deployment of a Dormia basket. We report on the use of the prototype forward viewing echoendoscope in six consecutive patients who were referred for pancreatic cyst drainage. Here you see endoscopic view-indistinguisable from that of a gastroscope-showing a bulge where the cyst impinges against the posterior gastric wall. Power Doppler is switched on and highlights multiple vessels interposed in the wall This allows selection of a safe vessel-free window for a cyst puncture A 19 G needle is advanced into the cyst lumen. A sample of contents is aspirated for fluid analysis. A guidewire under ultrasound guidance into the cyst. An 18mm balloon is coaxially thread over the wire and advanced across the cyst wall, Note that resistance is encountered, but the forward transfer of force overcome this. The dilation is performed under forward viewing endoscopuc and ultrasound guidance. As the balloon is maximally inflated we see the cystgastrostomy open up. The balloon is then deflated while simultaneously advancing the scope into the cyst cavity. Cystoscopy isnow performed showing the cyst contents to be filled with pasty wall-adherent necroses. Pulsed power Doppler is switched on we can see and hear arterial flow vessels within the wall of the cyst. This identifies sensitive areas at bleeding risk when performing debridement In this case vigorous water jet irrigation is performed through an accessory water irrigation channel built into the echoendoscope. This issued to clear nonadherent debris. Our experience has shown that it is not necessary to actively remove wall-adherent debris using extraction tools as such Dormia or Roth net basket to achieve cyst resolution. Three large bore 10 Fr double pigtail stents are now inserted into the cyst under direct endoscopic guidance. The first stent is delivered over a guide catheter. The second stent. And the third stent All three stents are deployed. Finally, a nasocystic catheter is inserted for maintenance irrigation. In another patient we used the Cook Cystome to perform cystgastrostomy. We have found the Cystotome easy to delivery through the forward viewing echoendoscope. As shown, we advance the Cystotome into the cyst while applying diathermy. This is performed under and endoscopic guidance, entering the cyst at a near perpendicular orientation. After entry, the Cystotome is removed and cyst fluid gushes from the cystagastrotomy site.