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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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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.
Majority of patients these days prefer PCNL ( Minimal Invasive Telescopic removal of kidney stones broken with lithoclast, removed through a button hole incision ). This patient with a big stone in the pelvis of the kidney wanted it open only so I did an open pyelolithotomy for this patient after a long time as I use to do it in routine in the past. Except for the long incision and scar as compared to PCNL the recovery time was the same and patient went home third day happily walking and eating.
In this video, Professor Dan Reinstein performs a bilateral LASIK procedure filmed in real-time to demonstrate the full 8 and-a-half minute procedure from multiple angles. The superior design and experience of the Carl Zeiss Meditec Visumax femtosecond Laser for flap creation is seen, where the patient is only in contact with the device for about 30 seconds with extremely low contract force such that the patient feels effectively nothing, there are no red splodges (subconjunctival haemorages) left behind. From the surgeons' standpoint there is no device that is easier to use or faster for LASIK flap creation. The Carl Zeiss Meditec MEL80 excimer laser portion of the procedure is seamlessly integrated and incorporates all the features that make clinical outcomes so reproducible including the unique cone-for-controlled-atmosphere (CCA) and high efficiency, high sensitivity calibration test which can be performed for each individual patient to compensate for minor changes in energy that occur with excimer laser devices during the course of a day.
For reference to the clinical outcomes for LASIK with the MEL80 in presbyopia using PRESBYOND Laser Blended Vision see:
Reading glasses presbyopia (ageing eyes) only:
LASIK for presbyopia correction in emmetropic patients using aspheric ablation profiles and a micro-monovision protocol with the Carl Zeiss Meditec MEL 80 and VisuMax.
J Refract Surg. 2012 Aug;28(8):531-41. Reinstein DZ, Carp GI, Archer TJ, Gobbe M.
http://www.ncbi.nlm.nih.gov/pubmed/22869232
Short sighted, astigmatism and presbyopia (ageing eyes)
LASIK for Myopic Astigmatism and Presbyopia Using Non-Linear Aspheric Micro-Monovision with the Carl Zeiss Meditec MEL 80 Platform.
J Refract Surg. 2011 Jan;27(1):23-37. Epub 2010 Mar 1.
Reinstein DZ, Archer TJ, Gobbe M.
http://www.ncbi.nlm.nih.gov/pubmed/20205360
Long-sighted, astigmatism and presbyopia (ageing eyes)
LASIK for hyperopic astigmatism and presbyopia using micro-monovision with the Carl Zeiss Meditec MEL80 platform.
J Refract Surg. 2009 Jan;25(1):37-58. Reinstein DZ, Couch DG, Archer TJ.
http://www.ncbi.nlm.nih.gov/pubmed/19244952
For more information about laser eye surgery and PRESBYOND Laser Blended Vision, please contact the London Vision Clinic on 020 7224 1005.
This covers some of the benefits, side effects and potential complications of LASIK Eye Surgery! Learn about the pros and cons of laser eye surgery and some pro tools to help you along the way.
📒 Show Notes and Resources 📒
LASIK Affordability Calculator
http://www.refractivealliance.....com/lasik-affordabil
Patient Guide to Refractive Surgery
https://www.aao.org/Assets/e89....0eb55-9bfa-465a-8422
Some Reference Articles for you folks who like to read
https://www.healio.com/ophthal....mology/journals/jrs/
Dry Eye Playlist
https://www.youtube.com/playli....st?list=PLzi60fSuOmP
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MEDICAL ADVICE DISCLAIMER: All content in this video and description including: information, opinions, content, references and links is for informational purposes only. The Author does not provide any medical advice on the Site. Accessing, viewing, reading or otherwise using this content does NOT create a physician-patient relationship between you and it’s author. Providing personal or medical information to the Principal author does not create a physician-patient relationship between you and the Principal author or authors. Nothing contained in this video or it’s description is intended to establish a physician-patient relationship, to replace the services of a trained physician or health care professional, or otherwise to be a substitute for professional medical advice, diagnosis, or treatment. You should consult a licensed physician or appropriately-credentialed health care worker in your community in all matters relating to your health.
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In this video you will find a laser eye surgery review. We cover the laser eye surgery procedure and how lasik eye surgery works. A large emphasis is on the benefits of laser eye surgery as well as potential side effects and complications. We even touch on the topic of lasik eye surgery gone wrong.
#lasikeyesurgery #lasiksurgery #lasik
atrial septal defect (ASD) is a hole in the wall between the two upper chambers of your heart (atria). The condition is present from birth (congenital). Small atrial septal defects may close on their own during infancy or early childhood. Large and long-standing atrial septal defects can damage your heart and lungs. Small defects may never cause a problem and may be found incidentally. An adult who has had an undetected atrial septal defect for decades may have a shortened life span from heart failure or high blood pressure that affects the arteries in the lungs (pulmonary hypertension). Surgery may be necessary to repair atrial septal defects to prevent complications
An intrauterine device (IUD), also known as intrauterine contraceptive device (IUCD or ICD) or coil, is a small, often T-shaped birth control device that is inserted into a woman's uterus to prevent pregnancy. IUDs are one form of long-acting reversible birth control (LARC).
The most frequent incision utilized to open the abdomen for liver surgery is called a chevron incision. In this incision a cut is made on the abdomen below the rib cage. The cut starts under the armpit below the ribs on the right side of the abdomen and continues all the way across the abdomen to the opposite arm pit thereby the whole width of the abdomen is cut to provide access to the liver. The average length of the incision is approximately 24 to 30 inches. This is one of the longest incisions is utilized in abdominal surgery. The incision is frequently associated with significant discomfort after the surgery and in some patients the discomfort can continue for many months, particularly when some of the nerves in the abdominal wall have been cut during the surgery. Laparoscopic surgery provides advantages over open surgery for the liver since the chevron incision is completely avoided and the surgery is performed through tiny incisions. As a consequence the duration of stay in hospital, the amount and duration of post operative discomfort, and the length of recovery is much shorter after the laparoscopic procedure compared to open surgery
Traditional Liposuction VS Vaser Liposuction
A side-by-side comparison of traditional liposuction and a #Vaser liposuction. Both of these were performed by our skilled surgeons at Divine Cosmetic Surgery.
#vaserliposuction #liposuction #liposuctionDelhi #liposuctionresults #shorts #vaserliposuctionDelhi
Know more about liposuction
https://www.divinecosmeticsurg....ery.com/liposuction-
Traditional Liposuction vs 360 High Def Vaser Liposuction - https://www.youtube.com/watch?v=r_bBI2p9fVI&t=14s
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Why Vaser Is Best For Thigh Liposuction - https://youtu.be/dlzpdDEZcS4
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Abdomen Vaser Liposuction - Live - https://www.youtube.com/watch?v=_Cvl2Txn8LQ
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Back Vaser Liposuction In Female - https://youtu.be/OC60UdgtIWU
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For more details about Liposuction Visit - https://www.divinecosmeticsurgery.com/
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Dr. Amit Gupta
MBBS, M.S., DNB (Plastic & Cosmetic Surgery)
Divine Cosmetic Surgery | +91 9811994417
info@divinecosmeticsurgery.com | 01141828787
Delhi | Mumbai | Gurgaon
𝗦𝗼𝗰𝗶𝗮𝗹 𝗠𝗲𝗱𝗶𝗮 𝗮𝗻𝗱 𝗬𝗼𝘂𝘁𝘂𝗯𝗲 𝘃𝗶𝗱𝗲𝗼 𝗰𝗵𝗮𝗻𝗻𝗲𝗹 : -
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#Liposuction #vaserliposuction #liposuctioncostinindia #liposuctiondelhi #liposuction #liposuctioncost #liposuctioncostfactors #liposuctioncostindelhi #DrAmitGuptaPlasticSurgeon #DivineCosmeticSurgery #dramitgupta
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To learn more about coronary artery bypass grafting (CABG), please visit https://cle.clinic/3b7dqpE
Cardiac surgeons Faisal Baaeen, MD and Edward Soltesz, MD talk about coronary artery bypass graft (CABG) surgery in this informative video.
They describe:
• how blockages are bypassed
• how vessels are used for the bypass graft
• reoperation experiences
• the importance of complete revascularization
• and options such as off pump bypass surgery and minimally invasive surgery
Dr. Bakaeen is the Director of the Coronary Artery Bypass Center at Cleveland Clinic. To learn more about him, please visit https://cle.clinic/2INN9AV
Dr. Soltesz is a cardiovascular and heart transplant surgeon. To learn more about him, please visit https://cle.clinic/3o86RMt
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#clevelandclinic #coronaryartery #bypasssurgery #heartsurgery #heartcare #cardiacsurgery
This video shows you how to conduct a clinical examination of the foot and how to identify common causes of foot pain.
This video clip is part of the FIFA Diploma in Football Medicine and the FIFA Medical Network. To enrol or to find our more click on the following link http://www.fifamedicalnetwork.com
The Diploma is a free online course designed to help clinicians learn how to diagnose and manage common football-related injuries and illnesses. There are a total of 42 modules created by football medicine experts. Visit a single page, complete individual modules or finish the entire course.
The network provides the opportunity for clinicians around the world to meet and share ideas relating to football medicine. Ask about an interesting case, debate current practice and discuss treatment strategies. Create a profile and log on to interact with other health professionals from around the globe.
This is not medical advice. The content is intended as educational content for health care professionals and students. If you are a patient, seek care of a health care professional.