At one time, women who had delivered by cesarean section in the past would usually have another cesarean section for any future pregnancies. The rationale was that if allowed to labor, many of these women with a scar in their uterus would rupture the uterus along the weakness of the old scar. Over time, a number of observations have become apparent: Most women with a previous cesarean section can labor and deliver vaginally without rupturing their uterus. Some women who try this will, in fact, rupture their uterus. When the uterus ruptures, the rupture may have consequences ranging from near trivial to disastrous. It can be very difficult to diagnose a uterine rupture prior to observing fetal effects (eg, bradycardia). Once fetal effects are demonstrated, even a very fast reaction and nearly immediate delivery may not lead to a good outcome. The more cesarean sections the patient has, the greater the risk of subsequent rupture during labor. The greatest risk occurs following a “classical” cesarean section (in which the uterine incision extends up into the fundus.) The least risk of rupture is among women who had a low cervical transverse incision. Low vertical incisions probably increase the risk of rupture some, but usually not as much as a classical incision. Many studies have found the use of oxytocin to be associated with an increased risk of rupture, either because of the oxytocin itself, or perhaps because of the clinical circumstances under which it would be contemplated. Pain medication, including epidural anesthetic, has not resulted greater adverse outcome because of the theoretical risk of decreasing the attendant’s ability to detect rupture early. The greatest risk of rupture occurs during labor, but some of the ruptures occur prior to the onset of labor. This is particularly true of the classical incisions. Overall successful vaginal delivery rates following previous cesarean section are in the neighborhood of 70 This means that about 30of women undergoing a vaginal trial of labor will end up requiring a cesarean section. Those who undergo cesarean section (failed VBAC) after a lengthy labor will frequently have a longer recovery and greater risk of infection than had they undergone a scheduled cesarean section without labor. Women whose first cesarean was for failure to progress in labor are only somewhat less likely to be succesful in their quest for a VBAC than those with presumably non-recurring reasons for cesarean section. For these reasons, women with a prior cesarean section are counseled about their options for delivery with a subsequent pregnancy: Repeat Cesarean Section, or Vaginal Trial of Labor. They are usually advised of the approximate 70successful VBAC rate (modified for individual risk factors). They are counseled about the risk of uterine rupture (approximately 1in most series), and that while the majority of those ruptures do not lead to bad outcome, some of them do, including fetal brain damage and death, and maternal loss of future childbearing. They are advised of the usual surgical risks of infection, bleeding, anesthesia complications and surgical injury to adjacent structures. After counseling, many obstetricians leave the decision for a repeat cesarean or VBAC to the patient. Both approaches have risks and benefits, but they are different risks and different benefits. Fortunately, most repeat cesarean sections and most vaginal trials of labor go well, without any serious complications. For those choosing a trial of labor, close monitoring of mother and baby, with early detection of labor abnormalities and preparation for

Electronystagmography (ENG) is a diagnostic test to record involuntary movements of the eye caused by a condition known as nystagmus. It can also be used to diagnose the cause of vertigo, dizziness or balance dysfunction by testing the vestibular system.

A very simplified method giving information about cystic fibrosis

In this video a case in which an infected implant was removed.He how the infected are progressed and shows how the implant was removed. He then discusses how the area will heal and when further surgery can be performed.

Surgeons Open Chest of Stabbed Patient to Pull Knife Out of His Heart

Follow along on a typical day with UCSF Medical Center's chief of cardiothoracic surgery Dr. Tom Nguyen. Take a walk on rounds with his team as they check on patients who are recovering or preparing for heart valve surgeries to treat conditions such as mitral valve prolapse and mitral regurgitation. Get a glimpse into the operating room as Dr. Nguyen and his team use the latest non-invasive techniques to help patients achieve the best outcomes.

0:00 Surgeon begins day with morning report
0:53 Meet with fellows and visit patients
1:28 Surgeon thoughts on his practice
Minimally Invasive Surgeries
2:09 Mitral valve replacement for mitral stenosis
3:11 Mitral valve repair for AFib and mitral regurgitation
3:36 Stopping the heart
4:15 Culture 1 - Everyone's voice matters
4:45 Mitral valve repair for heart murmur
5:12 Culture 2 - Patient first

To view more UCSF videos relating to Mitral Regurgitation Treatment and Aortic Stenosis Treatment view:
Mitral Regurgitation Treatment Options https://youtu.be/7nUUOMx4tJ0
Aortic Stenosis Treatment Options https://youtu.be/A2rZK0oFWcc

If you want to learn more about the Cardiac Surgery clinic and to request an appointment visit: https://www.ucsfhealth.org/cli....nics/cardiac-surgery



#dayinthelife #heartsurgeon #heartsurgery #CardiacSurgery #Cardiology #ucsf #drnguyen#ucsfhealth #Cardiothoracic

Endoscopic picture of turban epiglottis in patient of epiglottitis

What goes into providing anesthesia for cardiac surgery where a patient's heart is completely arrested? In this video, I take you into the operating room during a surgery and talk with Dr. Benji Salter, program director for Mt. Sinai Hospital's cardiothoracic anesthesiology fellowship program.

While no patient information is shown in this video, the patient did provide written consent for filming to occur during surgery. Permission was also obtained from Mount Sinai Hospital's Department of Anesthesiology as well as the hospital's Press Office.

Chapters
0:00 Start
0:44 Surgery background
1:40 Case preparation
2:45 Anesthesia equipment
6:21 Echocardiography
7:16 Preparing for bypass
8:34 Stopping the heart
9:06 Fellowship
10:46 Why cardiac anesthesia?
11:52 Coming off of bypass
13:06 Post-op recovery

The information in this video is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained in this video is for general information purposes only and does not replace a consultation with your own doctor/health professional.

#Anesthesiology #Residency #MedicalSchool

Vasculitis is an inflammation of your blood vessels. It causes changes in the walls of blood vessels, including thickening, weakening, narrowing and scarring. These changes restrict blood flow, resulting in organ and tissue damage. There are many types of vasculitis, and most of them are rare. Vasculitis might affect just one organ, such as your skin, or it may involve several. The condition can be short term (acute) or long lasting (chronic). Vasculitis can affect anyone, though some types are more common among certain groups. Depending on the type you have, you may improve without treatment. Or you will need medications to control the inflammation and prevent flare-ups. Vasculitis is also known as angiitis and arteritis.

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DRE

Shoutout to director/videographer Valentina Vee and producer Sean Tien for helping me bring this to life.

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Video about cardiovascula medical examination

A penile prosthesis is another treatment option for men with erectile dysfunction. These devices are either malleable (bendable) or inflatable. The simplest type of prosthesis consists of a pair of malleable rods surgically implanted within the erection chambers of the penis. With this type of implant the penis is always semi-rigid and merely needs to be lifted or adjusted into the erect position to initiate sex. This type of implant is a good choice for men with spinal cord injuries and/or limited hand strength. Today, many men choose a hydraulic, inflatable prosthesis, which allows them to have an erection when they choose, and it's easier to conceal. It is also more natural. A penile implant is usually used when there is a clear medical cause for ED and when the problem is unlikely to resolve or improve naturally or with other medical treatments. Sometimes a penile prosthesis is implanted during surgery to reconstruct the penis when scarring has caused erections to curve (Peyronie's disease). Penile implant surgeries take about an hour and are typically done in an outpatient center. A man can resume sexual intercourse by 6 weeks after surgery.

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This video illustrates an IM injection for deltoid muscle.
Note that vaccines and other medications can be administered through the deltoid muscle. I will give you some tips through this video.

It is important to check your client’s details such as their medication, time, dose, and the route to be used. Different research works are subject to change the protocols for insertion thus, it is necessary to be up to date with the current changes.

Assemble all the supplies and conduct hand sanitation. Usually, I wear gloves before giving any injection in as much as the CDC may state it is optional unless the patient has an open lesion and contact of body fluids is likely to happen.

Use the acromion process landmark to locate the deltoid muscle. Move your fingers about two widths below the landmark. The patient’s adipose tissue determines the choice of needle length. Note that the needle gauge is determined by the type of medication you plan to give to the patient.

The Z-track technique is recommended rather than pinching the patient’s skin. Pull the patient’s skin to the side using one hand. Use a 90 degree angle to insert the needle to the patient’s skin. At the rate of 10 seconds per mL gently depress the plunger.

Remove the needle carefully and engage the safety precautions then dispose of the needle appropriately in the sharps container. Gauzing helps to cover the injection site.

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A flail chest occurs when a segment of the thoracic cage is separated from the rest of the chest wall. This is usually defined as at least two fractures per rib (producing a free segment), in at least two ribs. A segment of the chest wall that is flail is unable to contribute to lung expansion. Large flail segments will involve a much greater proportion of the chest wall and may extend bilaterally or involve the sternum. In these cases the disruption of normal pulmonary mechanics may be large enough to require mechanical ventilation.

Eye Pressure Test

If the artery were severed, blood would flow out unimpeded, although the artery wall would contract in an effort to stop the bleeding. After losing >30% of one's blood volume blood pressure would start dropping, and with less pressure the rate of bleeding would go down. At this stage if the blood loss wasn't replaced the person could die. Losing halve to two thirds of one's blood volume is considered to be fatal even if later on blood transfusion is attempted. One's total blood volume at 70ml/kg is estimated to be between 5 to 7 liters, so that makes a blood loss of between 2,5 to 4,7 L.

What does the placenta do? The placenta is an organ that develops in your uterus during pregnancy. This structure provides oxygen and nutrients to your growing baby and removes waste products from your baby's blood. The placenta attaches to the wall of your uterus, and your baby's umbilical cord arises from it. In most pregnancies, the placenta attaches at the top or side of the uterus.