Friday, November 25, 2011

Abdominal Aorta Palpation Video

We report seven cases of dissection of the abdominal aorta. Three patients had acute back pain, whereas four patients had more chronic courses. In six cases, as a result of the palpation of a pulsatile abdominal mass,
clinical diagnosis was an atheromatous aneurysm. Angiography and CT scanning demonstrated a dissected abdominal aorta and a normal thoracic aorta. Six patients with an infrarenal dissection were treated by replacement of the aorta with a Dacron prothesis, and one patient with an suprarenal dissection was treated conservatively. With a mean follow-up of 3 years, all patients were alive and free of symptoms. These results favor graft replacement in case of infrarenal aortic dissection and more selective surgical indications in suprarenal aortic dissection.

 In the concrete assay of belly aortic aneurysm (AAA), the alone action of approved amount is belly palpation to ascertain aberrant addition of the aortic pulsation. Palpation of AAA appears to be safe and has not been appear to accelerate rupture. The best affirmation on the accurateness of belly palpation comes from 15 studies of patients not ahead accepted to accept AAA who were buried with both belly palpation and ultrasound. When after-effects from these studies are pooled, the acuteness of belly palpation increases decidedly with AAA bore (P<.001), alignment from 29% for AAAs of 3.0 to 3.9 cm to 50% for AAAs of 4.0 to 4.9 cm and 76% for AAAs of 5.0 cm or greater. Absolute and abrogating likelihood ratios with 95% aplomb intervals (CIs) application a blow point for AAAs of 3.0 cm or greater are 12.0 (95% CI, 7.4-19.5) and 0.72 (95% CI, 0.65-0.81), respectively, and for AAAs of 4.0 cm or greater are 15.6 (95% CI, 8.6-28.5) and 0.51 (95% CI, 0.38-0.67). The absolute predictive amount of palpation for AAA of 3.0 cm or greater in these studies was 43%. Limited abstracts advance that belly blubber decreases the acuteness of palpation. Belly palpation accurately directed at barometer aortic amplitude has abstinent acuteness for audition an AAA that would be ample abundant to be referred for anaplasty but cannot be relied on to exclude AAA, abnormally if breach is a possibility.

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Total Abdominal Hysterectomy
Abdominal hysterectomy is a surgical action that removes your uterus through an cavity in your lower abdomen. Your uterus — or abyss — is area a babyish grows if you're pregnant. Sometimes a hysterectomy includes abatement of one or both ovaries and fallopian tubes. Hysterectomy is one of the best accepted surgical procedures amid women. 

Hysterectomy can additionally be performed through an cavity in the vagina (vaginal hysterectomy) or by a laparoscopic or automatic surgical access — which uses laparoscopic instruments anesthetized through baby belly incisions. Belly hysterectomy may be recommended over added surgical approaches if you accept a ample uterus or if your doctor wants to analysis added pelvic organs for signs of disease. 



Lasik Surgery - 3D Medical Animation Video

What is LASIK?
The eye and eyes errorsThe genitalia of the eye. Indicated are the conjunctiva, sclera, choroid, optic nerve, retina, alcove angle, lens, cilary body, brittle humor, aqueous humor, iris, pupil, cornea.
The cornea is a allotment of the eye that helps focus ablaze to actualize an angel on the retina. It works in abundant the aforementioned way that the lens of a camera focuses ablaze to actualize an angel on film. The angle and absorption of ablaze is additionally accepted as refraction. Usually the appearance of the cornea and the eye are not absolute and the angel on the retina is out-of-focus (blurred) or distorted. These imperfections in the absorption ability of the eye are alleged refractive errors. There are three primary types of refractive errors: myopia, hyperopia and astigmatism. Persons with myopia, or nearsightedness, accept added adversity seeing abroad altar as acutely as abreast objects. Persons with hyperopia, or farsightedness, accept added adversity seeing abreast altar as acutely as abroad objects. Amaurosis is a baloney of the angel on the retina acquired by irregularities in the cornea or lens of the eye. Combinations of amaurosis and amaurosis or hyperopia and amaurosis are common. Glasses or acquaintance lenses are advised to atone for the eye's imperfections. Surgical procedures aimed at convalescent the absorption ability of the eye are alleged refractive surgery. In LASIK surgery, absolute and controlled abatement of corneal tissue by a appropriate laser reshapes the cornea alteration its absorption power.
Other types of refractive surgery
Radial Keratotomy or RK and Photorefractive Keratectomy or PRK are added refractive surgeries acclimated to adapt the cornea. In RK, a actual aciculate knife is acclimated to cut slits in the cornea alteration its shape. PRK was the aboriginal surgical action developed to adapt the cornea, by sculpting, application a laser. Later, LASIK was developed. The aforementioned blazon of laser is acclimated for LASIK and PRK. Often the exact aforementioned laser is acclimated for the two types of surgery. The above aberration amid the two surgeries is the way that the stroma, the average band of the cornea, is apparent afore it is vaporized with the laser. In PRK, the top band of the cornea, alleged the epithelium, is aching abroad to betrayal the stromal band underneath. In LASIK, a accessory is cut in the stromal band and the accessory is bankrupt back. 

Another blazon of refractive anaplasty is thermokeratoplasty in which calefaction is acclimated to adapt the cornea. The antecedent of the calefaction can be a laser, but it is a altered affectionate of laser than is acclimated for LASIK and PRK. Added refractive accessories accommodate corneal arena segments that are amid into the stroma and appropriate acquaintance lenses that briefly adapt the cornea (orthokeratology).


Knee Replacement Surgery Video

Who Needs Knee Backup Surgery?
A being may appetite to accede knee backup anaplasty if they accept a stiff, aching knee that prevents them from assuming alike the simplest of activities and added treatments are no best working.
What Happens During Knee Backup Surgery?

Once you are beneath accepted anesthesia (meaning you are briefly put to sleep), spinal, or epidural (numb beneath the waist) anesthesia, an eight- to twelve-inch cut is fabricated in the advanced of the knee. The damaged allotment of the collective is removed from the apparent of the bones, and the surfaces are again shaped to authority a metal or bogus bogus joint. The bogus collective is absorbed to the thigh bone, shin and knee cap either with adhesive or a appropriate material. When fit together, the absorbed bogus genitalia anatomy the joint, relying on the surrounding anatomy and ligaments for abutment and function.
What Are Recent Advances in Knee Backup Surgery?
Minimally invasive anaplasty (MIS) has revolutionized knee backup anaplasty as able-bodied as abounding fields of medicine. Its key appropriate is that it uses specialized techniques and chart to accredit the surgeon to accomplish above anaplasty after a ample incision. 

MIS knee collective backup requires a abundant abate incision, three to bristles inches, against the accepted access and incision, which is about eight to twelve inches. The smaller, beneath invasive approaches aftereffect in beneath tissue agony by acceptance the surgeon to assignment amid the fibers of the quadriceps anatomy instead of acute an cavity through the tendon. It may advance to beneath pain, decreased accretion time and more good motion due to beneath blister tissue formation.
Currently this beneath invasive action is performed by alone a baby allotment of orthopaedic surgeons in North America. Because this blazon of anaplasty is still almost new, analysis has been accomplished to actuate how the actual and abiding after-effects will analyze to acceptable surgery.


Auscultation of the heart VIDEO


Auscultation is an capital allotment of alike a brief cardiac exam. Listening to the affection you can accumulate advice about the 1) amount and rhythm, 2) amount activity (e.g. stenosis, regurgitation/insufficiency), and 3) anatomical defects (e.g. atrial septal defects, ventricular septal birthmark (VSD), hypertrophy).?
In anecdotic and documenting a murmur, you should be able to characterize 4 backdrop of an “abnormal” affection sound:

-The area of the affection complete on the chest (i.e. area is it heard loudest and area you can apprehend the complete at all).

-The timing of the affection complete (i.e. aboriginal diastolic, pan systolic, etc.)

-The brand or acuteness of the affection complete (i.e.1-6 (see table below))

-The affection and appearance of the affection complete (i.e. agreeable crescendo, acrid snap, etc.)

Where to abode your stethoscope
Picture of 4 archetypal cardiac ausculation breadth on the chest.As with palpation of the heart, auscultation should advance in a analytic address over 4 accepted areas on the antecedent chest, alpha with the accommodating in the collapsed position. The 4 percordial areas are advised with diaphragm, including:
Aortic arena (between the 2nd and 3rd intercostal spaces at the appropriate sternal border) (RUSB – appropriate high sternal border).
Pulmonic arena (between the 2nd and 3rd intercostal spaces at the larboard sternal border) (LUSB – larboard high sternal border).
Tricuspid arena (between the 3rd, 4th, 5th, and 6th intercostal spaces at the larboard sternal border) (LLSB – larboard lower sternal border).
Mitral arena (near the acme of the heard amid the 5th and 6th intercostal spaces in the mid-clavicular line) (apex of the heart).
After this antecedent assay in the collapsed positions, several added assignment should be able in the absolute cardiac exam, as follows:
Instruct the accommodating to about-face assimilate their larboard ancillary (left decubitus position) and accept with the alarm of the stethoscope at the acme for mitral binding (low pitched diastolic murmur).
Instruct the accommodating to sit cocked and check the 4 percordial regions, afresh with the diaphragm of the stethoscope.
Instruct the accommodating to angular forward, exhale, and authority their breath. Accept with the diaphragm amid the additional and third intercostal spaces at the appropriate sternal (aortic) and larboard sternal (pulmonic) areas for aortic regurgitation


ECG Leads Placement

ECG Lead Placement
The arrangement of accession of leads for assuming a 12-lead ECG is universal. This helps to ensure that, back a person's ECGs are compared, any changes on the ECG are due to cardiac injury, not a aberration in adjustment of leads, this is acutely important with the accretion use of adopted travel. There are accepted standards in abode throughout the world.
Interpretation of the allegation can alter from doctor to doctor but methods for accepting the advice are the aforementioned the apple over.
These positions may alter hardly back a accommodating is on connected cardiac monitoring. The leads commonly absorbed to wrists and ankles will be placed on amateur and lower belly so that movement of limbs has basal aftereffect on the accent trace. 

These positions may additionally alter if a accommodating is afraid (maybe due to Parkinson's Disease or hypothermia) or has beef tremors. In this bearings the leads may be confused assimilate the thighs and forearms.
Seeing an ECG actuality performed will attending article like the arena below. As you can see, the borderline leads are accurately placed on wrists and ankles.


How to read ECG Videos

Contents: Introduction, PQRST Terminology, The 12 leads, Cardiac cycle. Estimation of PQRST Patterns: Calcuation of rate, Axis deviation, Atrial hypertrophy, Ventricular Hypertrophy, Bundle Branch Blocks, Myocardial Infarct, Myocardial Ischaemia, WPW Syndrome. Rhythm Abnormalities: Classification, Premature beats, Sinus Pause, Sinus rhythms, Atrial rhythms, Ventricular rhythms, AVBlocks. Effect of Drugs & Electrolytes: Digitalis, Potassium, Calcium, Quinidine. Systematic estimation of ECGs. ST-T changes: ST depression, ST elevation, T beachcomber inversion, Tall T waves. Revision
First video
How to read ECG Video Part -1

2nd video
How to read ECG Video Part -2

Third video
How to read ECG Video Part -3



ECG dancing

I aboriginal saw this some years ago at uni. It demonstrates the arrangement of contest during assorted cardiac episodes. It is the badgers nadgers!

The assistant uses his accoutrements to simulate the two top accommodation of the heart…the Atria. He uses his legs to simulate the two lower accommodation of the heart…the Ventricles.
So the atria arrangement calm followed by the ventricles application calm and claret is pumped about the body.
When apparent on an ECG (electrocardiogram…EKG in the USA) the contractions of the affection are apparent as the electrical impulses that accomplish the cardiac beef to move. These are the altered complexes apparent on an ECG recording…normally the PQRST complex.

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Thursday, November 17, 2011

Pulmonary Angiography

  1. Indications
    1. Suspected Pulmonary Embolism
      1. Discordant VQ Scan and Clinical picture
  2. Advantage
    1. Gold standard for diagnosing Pulmonary Embolism
    2. Sensitivity: 98%
  3. Disadvantage
    1. Mortality 0.1 - 0.5% (especially in unstable patients)


Chest X-ray Interpretation

What is a chest X-ray?

A chest X-ray is  exposing the chest briefly to radiation to produce an image of the chest and the organs in the chest. An X-ray film is positioned against the body opposite the camera,and there is two view anterior-posterior and lateral view. which sends out a small dose of a radiation beam. As the radiation penetrates the chest wall, it is absorbed in varying amounts by different body tissues depending on the tissue's composition of air, water, blood, bone, or muscle. Bones, for example, absorb much of the X-ray radiation while lung tissue (which is filled with mostly air) absorbs very little, allowing most of the X-ray beam to pass through the lung.
Watch this video: 

Systematic Review:


  • General
    1. See XRay Interpretation
    2. Compare findings from side to side
  • Alignment
    1. Note if patient is lordotic or kyphotic
    2. Note patient rotation
      1. Spinous processes midway between clavicle heads
  • Specific points of exam
    1. Lines and Tubes
    2. Bones
    3. Soft tissues
    4. Pleural spaces
    5. Mediastinum
    6. Cardiovascular structures
    7. Lung parenchyma
    8. Infradiaphragmatic areas
  • Standard Checks

    1. Hilum is higher on the left
    2. Hemidiaphragm is lower on the left
      1. May be variable in older patients
    3. Right hemidiaphragm sharply outlined
    4. Left hemidiaphragm sharply outlined lateral to apex
    5. Localize any lesion on both lateral and AP
    6. Endotracheal Tube should be above carina
      1. Usually overlies 5-6th vertebrae
    7. Trace intravenous lines along entire course
    8. Trace Nasogastric Tubes along entire course
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    Wednesday, November 16, 2011

    Ct Scan Chest

    What is CT Scanning of the Chest?

    CT scanning—sometimes alleged CAT scanning—is a noninvasive medical analysis that helps physicians analyze and amusement medical conditions.
    CT scanning combines adapted x-ray accessories with adult computers to aftermath assorted images or pictures of the central of the body. These cross-sectional images of the breadth actuality advised can again be advised on a computer monitor, printed or transferred to a CD.
    CT scans of centralized organs, bones, bendable tissue and claret argosy accommodate greater accuracy and acknowledge added capacity than approved x-ray exams. 

    Using a array of techniques, including adjusting the radiation dosage based on accommodating admeasurement and freshcomputer application technology, the bulk of radiation bare to accomplish a chest CT browse can be decidedly reduced. A low-dose chest CT produces images of acceptable angel affection to ascertain abounding lung diseases and abnormalities application up to 65 percent beneath ionizing radiation than a accepted chest CT scan. This is abnormally accurate for audition and afterward lung cancer. Other diseases, such as the apprehension of pulmonary array and interstitial lung ache may not be adapted for low-dose chest CT. Your radiologist will adjudge the able settings to be acclimated for your browse depending on your medical problems and what advice is bare from the CT scan. If your adolescent is to accept a CT scan, the able low-dose pediatric settings should be used.

    What are the benefits vs. risks?

    CT is fast, which is important for patients who accept agitation captivation their breath.

    CT scanning is painless, noninvasive and accurate.

    A above advantage of CT is its adeptness to angel bone, bendable tissue and claret argosy all at the aforementioned time.

    Clashing accepted x-rays, CT scanning provides actual abundant images of abounding types of tissue as able-bodied as the lungs, bones, and claret vessels.

    CT examinations are fast and simple; in emergency cases, they can acknowledge centralized injuries and bleeding bound abundant to advice save lives.

    CT has been apparent to be a cost-effective imaging apparatus for a advanced ambit of analytic problems.

    CT is beneath acute to accommodating movement than MRI.

    CT can be performed if you accept an built-in medical accessory of any kind, clashing MRI.

    CT imaging provides real-time imaging, authoritative it a acceptable apparatus for allegorical minimally invasive procedures such as aggravate biopsies and aggravate aspirations of abounding areas of the body, decidedly the lungs, abdomen, abdomen and bones.

    A analysis bent by CT scanning may annihilate the charge for basic anaplasty and surgical biopsy.

    No radiation charcoal in a patient's anatomy afterwards a CT examination.

    X-rays acclimated in CT scans usually accept no actual ancillary effects.

    Low-dose CT scans of the chest use a lower dosage of radiation than accepted chest CT.


    There is consistently a slight adventitious of blight from boundless acknowledgment to radiation. However, the account of an authentic analysis far outweighs the risk.

    The able radiation dosage for this action varies. See the Safety folio for added advice about radiation dose.

    Women should consistently acquaint their physician and x-ray or CT technologist if there is any achievability that they are pregnant. See the Safety folio for added advice about abundance and x-rays.

    CT scanning is, in general, not recommended for abundant women unless medically all-important because of abeyant accident to the baby.

    Nursing mothers should delay for 24 hours afterwards adverse actual bang afore resuming breast-feeding.

    The accident of austere allergic acknowledgment to adverse abstracts that accommodate iodine is acutely rare, and radiology departments are well-equipped to accord with them.

    Because accouchement are added acute to radiation, they should accept a CT assay alone if it is capital for authoritative a analysis and should not accept again CT exams unless actually necessary. CT scans in accouchement should consistently be done with low-dose technique.


    Breech presentation C-Section

    Breech Presentation 

    Breech presentation is defined as a fetus in a longitudinal lie with the buttocks or feet closest to the cervix. This occurs in 3-4% of all deliveries. The percentage of breech deliveries decreases with advancing gestational age from 22% of births prior to 28 weeks' gestation to 7% of births at 32 weeks' gestation to 1-3% of births at term

    There are boundless fears surrounding vaginal commitment of the backside presentation and a abridgement of admonition about accessible on safe vaginal commitment of a breech. There is additionally a abridgement of bluntness about the risks of caesarean area and dispersed ability of the post-caesarean difficulties abounding mothers encounter. These factors, calm with the prevailing belief and behavior that caesareans agreement advantageous babies, added about than not leave the woman with no advantage but to blindly acquire the decisions fabricated for her by her obstetrician.
    Mothers may not be acquainted abundant beforehand than 36-37 weeks that their babyish actual in a backside position is a problem. The prevalence of backside presentation decreases from about 15% at 29-32 weeks evolution to amid 3-4% at term.(1)
    Many hospitals accept a action of constituent caesarean area at 38 weeks evolution for all backside presentations. For abounding mothers, decidedly those who accept fabricated abundant efforts to maximise the affairs of 'as accustomed a bearing as possible', such a position is acutely confidence-shattering and badly abashing - accident of ascendancy of, or captivation in, the commitment of her babyish is about total.
    In fact, a mother in such a position does accept three capital choices although these are absurd to be fabricated accustomed to her:
    Constituent caesarean section
    Vaginal backside commitment or vaginal backside abstraction application forceps
    Natural, alive backside birth

    Despite the boundless accepting that backside babies should be delivered by caesarean section, it has not been accurate to be safer for the babyish than accustomed alive backside birth. An all-embracing multi-centre Appellation Backside Balloon is currently actuality undertaken to attending at the catechism of which is the added acceptable admission for administration of the backside babyish at term: planned caesarean area or planned vaginal birth.
    Estimates of the perinatal bloodshed attributable to vaginal commitment of backside presentation accept varied, but it is about accustomed to be four times that for cephalic presentation aback adapted for abnormalities. However, in a analysis of over 10,000 backside births in eighty-six hospitals world-wide, Fortney et al (1986)(2) begin that the neonatal bloodshed amount in backside births was about alert the all-embracing neonatal bloodshed rate.
    The sad actuality is that babies in the backside position are at college accident than cephalic babies. Unfortunately boundless use of caesarean commitment for backside babies has not approved an advance in the aftereffect statistics.
    Caesarean operations do not agreement commitment of advantageous babies, backside or otherwise. Neither are all the 'hazards' of vaginal commitment consistently avoided. Backside presenting babies are still built-in basal aboriginal alike aback delivered operatively.
    "It is incorrect to accept . . . that caesarean backside commitment is never alarming for the fetus. Several attendant studies accept credible that brachial abdomen injury, accident to bendable tissues, fractures, lacerations, and affair of the fetal arch abaft the uterine cavity followed by intracranial drain action in caesarean backside deliveries as well."(3)
    Some obstetricians adopt to use a low vertical, rather than a transverse, uterine cavity aback carrying a backside babyish by caesarean aback vertical incisions can be continued with beneath accident to the mother should the charge arise. This, of course, has implications for approaching deliveries aback it is broadly believed that vertical scars are at hardly college accident of rupture.
    The capital fears surrounding vaginal backside commitment are bearing agony and asphyxia. With a breech, the after-coming arch does not accept an befalling to mould afore casual through the bearing canal. If the babyish is babyish or abortive there is a crisis that the anatomy may bear calmly abrogation the arch trapped abaft an clumsily aggrandized cervix or an bare pelvis.
    However, Collea et al (1978) point out that "excessively apathetic commitment of the arch may aftereffect in fetal asphyxia, although begin no absolute accord amid umbilicus-to-mouth commitment time and Apgar score."(4)

    As the amount of caesarean commitment of backside babies rises, beneath and beneath midwives and doctors are acquirements the abilities of vaginal backside delivery. In cases area the baby's arch does get trapped the bearing associates may act afield by angrily extracting the babyish which may account astringent academician and analgesic bond injuries, able-bodied adequate to account hyperbilirubinemia, agony to the liver, kidneys, annoyance and adrenals.
    In the ICEA analysis Commitment Alternatives in the Appellation Backside Abundance the angle of Irwin Kaiser, an American ob/gyn are noted:
    "I accept never in my activity had agitation with a breech. And I not about area for a breech. Now, of advance there are some abilities complex in carrying breeches. And, abounding doctors accomplished today aren't acquirements them. However, if doctors don't accept the skills, maybe they care to be accomplishing article abroad - conceivably authoritative medecine."(3)
    Although in approach backside babies are not benefiting from caesarean delivery, they may able-bodied be accomplishing so in practice, because the abilities of vaginal backside commitment are actuality lost.
    Another abundant accurate abhorrence in affiliation with vaginal backside bearing is bond prolapse. Aback the baby's basal or legs do not fit the abdomen as carefully as the arch there is added adventitious that the bond may blooper through. However, for the aforementioned affidavit the burden on the bond may not be as great, accordingly a bond alight with a backside may not be the anon life-threatening accident that about presents with a arch bottomward baby. Although Confino, et al begin that umbilical bond alight was abundant added accepted in backside presentations (3.7%) than in acme presentations (0.3%)(5), bond alight may not necessarily be as adverse in backside presentations as it is in acme presentations, because the fetal legs may absorber the prolapsed bond from compression. There is abstract which cites abundant instances of bond alight in backside deliveries afterwards any credible adverse aftereffect on the fetus.
    To those who accurate the agnosticism that the aerial amount of caesarean area for backside presentations has bigger aftereffect statistics, bound comes the acknowledgment "but they don't do aftereffect studies!". In fact, there accept been two broadly quoted studies which begin no aberration amid backside breed delivered vaginally and backside breed delivered by caesarean.
    It would arise that in the case of a advantageous mother with a advantageous babyish of accustomed admeasurement in a backside presentation, vaginal commitment at abounding appellation care to be an advantage to be accustomed austere application 'Informed choice' is actual abundant the 'in' affair at present, but how about does this arise with a woman whose babyish is in a backside presentation?
    It is not about acknowledged, for instance, that there are two actual altered 'types' of vaginal delivery. About speaking 'vaginal backside extraction' would added acceptable call what the majority of British hospitals accept to action as a 'vaginal backside delivery' option. This about involves some or all of the following:
    Getting to the hospital aboriginal in labour (in case of bond prolapse)
    Continuous fetal monitoring
    Epidural (to abstain the mother blame too aboriginal and of advance it can be topped up if a caesarean becomes necessary)
    Mother in lithotomy position (flat on back, legs in stirrups - so the doctor has 'good' access)
    Large episiotomy (to board the forceps)
    Complex abetment with forceps
    'Natural, active' backside bearing is not about the norm, although there are some midwives and the casual obstetrician who accede backside as artlessly a aberration of normal.
    Michel Odent's accustomed agreement for backside bearing involves no action whatsoever in the aboriginal date of labour, abrogation the woman chargeless and 'naturally active'. In his book 'Birth Reborn' he writes that his abandoned action is to:
    "insist on the accurate clearing position for delivery, aback it is the best mechanically efficient. It reduces the likelihood of our accepting to cull the babyish out, and is the best way to minimise the adjournment amid the commitment of the baby's umbilicus and the baby's arch . . . would never accident a backside commitment with the mother in a afterwards or semi-seated position."
    "If, on the added hand, contractions in the aboriginal date labour are aching and inefficient and aborticide does not progress, we charge bound allocate with the abstraction of vaginal delivery. Contrarily we face the crisis of a aftermost minute 'point of no return' when, afterwards actualization of the baby's buttocks, it is too backward to about-face strategies and adjudge on a caesarean. However, although we consistently accomplish caesareans aback aboriginal date labour is difficult and the bearings is not improving, best backside births in our dispensary do end up as vaginal deliveries."(8)
    Whether to opt for a caesarean, a balloon of labour catastrophe in a vaginal backside extraction, or a accustomed alive backside bearing is a actual difficult accommodation for an abandoned mother, decidedly if she is a aboriginal time mother.
    Even if she has abounding admonition she has to counterbalance the risks of caesarean area to herself and her babyish adjoin the accessible risks to the babyish of vaginal delivery. The bloodshed ante for backside babies are at atomic two-to-four times college than that for cephalic presentations. Aerial ante of caesarean area for backside presenting babies accept not been accepted to advance aftereffect statistics, but the risks complex in accessible commitment abide abundantly unacknowledged, arbitrarily absolved and are presented on the accomplished as actuality about added acceptable.
    Many women may able-bodied be agreeable to go forth with the medical admonition actuality presented to them and opt for an constituent caesarean at 38 weeks. They may accede the risks of an constituent area added acceptable, abnormally if their aplomb that the medical profession 'know best' is strong. The anticipation of a possibly continued and difficult labour which could still end in an emergency caesarean, conceivably beneath accepted anaesthetic, may arise added alarming and assume absurd aback they could align to agenda an epidural area at a possibly added 'convenient' time. Although the accepted availability of analgesic anaesthetic should accomplish use of a accepted anaesthetic unlikely.
    Elective caesarean is additionally the advantage which encounters atomic attrition and best abutment aback few obstetricians today would debris a caesarean to a woman with a backside presenting baby. Added mothers too, are abundant added acceptable to accept such a accommodation aback abounding accept heard ambiguous abhorrence belief of backside births consistent in asleep or brain-damaged babies.
    An added disadvantage to an constituent caesarean area is that the babyish does not account from experiencing contractions. It is believed that the contractions of labour, calm with the access bottomward the bearing canal, advice adapt the baby's lungs for breath air and about 'wake up' assorted systems in the body.(9) Babies built-in by caesarean afore the access of labour accept a college accident of lung disorders. 
    Some mothers may acquisition themselves actuality brash by medical professionals at one of the babyish and anytime abbreviating cardinal of hospitals that do still action a 'trial of labour' culminating in a 'vaginal backside extraction'. Such an advantage at atomic enables the mother to go into labour spontaneously, enabling the baby's lungs to account from contractions. It additionally gives the babyish a best befalling to turn.
    Major belly anaplasty can be avoided. What is more, provided the woman manages to advance the babyish out - admitting actuality in the best mechanically unfavourable position for accouchement accessible (bar actuality afraid upside down) - she will, at least, accept had a 'normal' birth.


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    Amazingly some women do absolutely administer to accord bearing in such circumstances, some so rapidly that there is no time for epidurals or forceps. Women who accept no built-in abhorrence or alarming of the lithotomy position and acceptable levels of aplomb in both themselves and their bearing associates can alike accept absolute bearing experiences, admitting the backside presentation.
    One mother who managed to accord bearing beneath aloof such altitude afore her associates were ready, commented to me that she begin the stirrups advantageous because they gave her article to advance adjoin and that it would accept been added acceptable if they'd been bedlam because they'd aching her feet.
    Apart from the accessible advantages of alienated anaplasty it is absurd that a woman planning to bear a backside via the 'vaginal route' will be abounding by an amateur midwife - she should be cared for by addition who is accomplished in backside deliveries and who is abreast with the problems and risks involved. Aback backside presentations are almost attenuate such a being is acceptable to be one of the added accomplished midwives or doctors at the hospital. There is abutment too for this advantage aback it has medical sanction.
    The disadvantages are that labour may be continued and difficult and may end, afterwards all, in a caesarean. Women who accept able during abundance for a accustomed alive bearing may not be able to cope emotionally with the anticipation of epidural, lithotomy, and forceps. Alike if commitment is accomplished beneath such affairs some women may still ache emotionally due to 'loss of control' and animosity that they accept not 'given birth' as they had hoped to do.
    So, what of the woman who is advantageous abundant to be able-bodied abreast and who takes the actual abnormal accommodation to abide 'naturally active' and accord bearing to her backside presenting babyish in a accurate continuing squat? How abundant account is such an 'informed choice' acceptable to engender? How abundant absolutely absorbed co- operation is she acceptable to encounter?
    The accepted acknowledgment from the all-inclusive majority of our maternology bloom professionals is actual acutely acceptable to be at best annoying and at affliction absolute threatening. It is an allegation of our maternology casework that if she deeply refuses to accomplish the 'right' best she is acceptable to acquisition herself aggravating to accord bearing alone, unassisted, unsupported, amidst by bearing associates arising fear, with a ready-and-waiting operating theatre bottomward the hall, complete with surgeon, knife at the ready, cat-and-mouse for the aberrant accommodating to appear to her senses.

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    Nasal Irrigator and nasal irrigation

    Breathe accessible and easy with Nasaline from ENTpro. The easy, comfortable, and safe adjustment to adulterate your nasal cavities with acrid band-aid to finer amusement affection associated with colds, the flu, allergies or sinusitis.
    Nasaline is a nasal rinsing accessory acclimated to decongest and cesspool blocked nasal passages finer abrasion abroad exceptionable mucous, band secretions, or allergens to advice accommodate abatement from affection associated with allergies, colds, the flu or sinus-related infections. All accustomed - Nasaline is the safe, able way to bright your nasal passages after medication

    How to Use Nasaline® Mix Salt In Water 1. Mix 1 packet (1/2 teaspoon) of Nasaline salt into 1 cup (8 ounces) of warm water (ca 2.5 grams salt into 1/4 liter water). Stir to dissolve the salt. Extract solution into syringe 2. Extract the saline solution into the Nasaline applicator. Push saline solution into the nostril Saline solution fills the nasal cavity Repeat the process for the other nostril 3. Stand (or sit) slightly bent over a bathroom sink, washbasin, or bathtub. Put the silicone tip against the nose so that it completely seals the nostril. Slowly push the saline solution up into the nostril. Breathe normally (or say aaah...) through the mouth and refrain from swallowing. When the saline solution reaches the back of the nasal cavity, the palate closes automatically by reflex. The saline solution fills the nasal cavity and proceeds to pour out of the other nostril as it brings along unwanted mucus and crusty secretions. Occasionally, some of the saline solution can trickle down the throat. This is not harmful. A proper flushing should take anywhere from 3-7 seconds per nostril depending on level of congestion, narrowness of ones nasal passages or personal preference. Repeat the process for the other nostril. Gently blow out any remaining solution in the nose 4. Use a tissue to gently blow out any remaining saline solution in the nose. Some of the saline solution can remain in the nose and trickle out a few hours later. Tilting your head forward and turning side to side immediately after flushing can prevent this. If you are severely congested, the saline solution can reach the sinus channels and can occasionally drip out of the eyes. This is not harmful and can be prevented by flushing more slowly.


    Eye Fish Hook Removal

    In this video you will see how to remove fish hook penetrating the cornea of the eye by video step by step.
    first is corneal section and insertion of lens glide and you can enlarge the entry to remove this fish hook you can follow this video
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    topic: Removal of a foreign body from the eye (fish hook)


    Pupil examination video

    Pupillary Abnormalities
    Their Recognition and Diagnosis
    Starting With The Basics:
    Evaluating a patients pupils starts back you aboriginal accommodated the patient. You are actuality accomplished to be a actual adroit observer. Therefore, the patient's adherent admeasurement and adequation are article you should mentally agenda and beam in the cat-and-mouse room. Furthermore, you should agenda the way the accommodating walks, carries their head, their accent pattern, facial features, e.g., scars, lip soars, bloom of their eyes, anatomical area of their eyes, etc. These observations could advice adviser the administration of your case history and ultimately added testing.

    The pupillary ablaze reflex is a four neuron arc. The aboriginal neuron connects the retina to the pretectal basis in the midbrain at the akin of the above colliculus. The additional neuron (internuncial neurons) connects anniversary pretectal basis to both Edinger-Westphal nuclei, appropriately answer why a unilateral ablaze bang evokes a mutual adherent constriction. The third neuron connects the Edinger-Westphal basis to the ciliary ganglion. The fourth neuron leaves the ciliary ganglion and innervates the sphincter muscle.
    The affectionate assumption accumulation to the eye is a three neuron arc. The aboriginal neuron (Preganglionic) starts in the after hypothalamus and terminates in the ciliospinal centermost of Budge. The additional neuron (Preganglionic) passes to the above cervical ganglion. The third neuron (Postganglionic) joins the ophthalmic analysis of the trigeminal assumption to ability the ciliary anatomy and the adherent dilator beef via the nasociliary and continued ciliary nerves.
    Watch this video:

     Anisocoria: The two pupils are not of according size.
    Light-near dissociation, refers to a action area the ablaze reflex is absent or aberrant but the abreast acknowledgment is intact. There is no analytic action in which the ablaze reflex is present and the abreast acknowledgment is absent.
    What follows are alone several means of recording your pupillary allegation there are of advance others.

    Recording Your Observations And Findings

    Iris Color
    Pupil Size
    Direct And Consensual Pupil Reflex
     Accommodation Pupillary Reflex
    Pupil Shape
    Afferent Pupil Defect
    Gn / Gn
    4mm/4 mm
    3 / 3__3 / 3
    ++ / ++
    - APD / OU

    The speed of the pupil reaction can be broken down in the following way:
    Brisk: = 4 To 3
    Sluggish: = 2 To 1
    None: = 0
    Brisk: = ++
    Sluggish:= +
    None: = 0
    Size = S
    Direct = D
    Consensual = C
    Accommodation = Acc
    Shape = Sh
    R = Round
    O = Oval
    S = Sector
    IRR = Irregular
    Afferent Pupil Defect=APD:
    (-APD) = Neg
    (R)APD = Right
    (L)APD = Left
    - APD
    The abbreviation "PERRLA" stands for Pupils Equal Round Respond to Light and Accommodation. Which tells a doctor very little to nothing about the patient's pupillary status the day they had their examination. Therefore, you may see it used, but it is not clinical protocol and no longer generally used.
    Depending on the author, approximately 25% of the population have unequal pupils of some degree with no known etiology or pathological consequences. This should not be misconstrued that unequal pupils are normal and benign findings.

    Detection and Analysis of Pupillary Defects:
    Examination of the pupillary reactions should be performed in a semidarkened room. The accommodating should be examination a abroad article back testing the pupillary reactions. This prevents both accommodative and aggregation from advancing into play. Accordingly, if a accommodating has anisocoria the pupils should be reassessed in capricious illumination. Generally speaking, patients who accept anisocoria that varies with beam levels are added doubtable of accepting a dissection etiology.
    Light Reflex:
    Have the accommodating appearance a abroad ambition again a abreast target. Be abiding to beam both eyes to affirm the responses are according and symmetrical.
    1. ) It is important that both absolute and consensual reflexes be assessed.
    2. ) If the afferent arc is complete the absolute acknowledgment should be according to the consensual reflex.
    3. ) It is additionally important that the ablaze antecedent NOT be shined anon into the patient's eye. The ablaze antecedent should be directed from hardly inferior and advancement against the patient's pupil.
    Near Reflex Triad:
    1) Accommodation
    2) Convergence
    3) Pupillary Constriction
    Near Reflex: Accept the accommodating appearance a abroad ambition again a abreast target. Be abiding to beam both eyes to affirm the responses are according and symmetrical.
    It is important you booty a analytical access to appraisal your patient's pupils. Even if the pupils are diff you absolutely do not apperceive which is the adulterated eye.
    A.) Are the patents beheld acuities equal, adapted or with pinholes?
    B.) Are the patients pupils diff in size?
    1.) If not, is there a change in the admeasurement in altered illuminations?
    a.) Is there a beyond access in anisocoria in the aphotic than in the light? (Very diagnostic)
    See breeze chart!
    b.) Is there a beyond access in anisocoria in the ablaze than in the dark? (Very diagnostic)
    See breeze chart!
    C.) Are the pupils according in size? If they are then:
    1.) Is the absolute ablaze reflex appropriately able in both eyes or added apathetic in one eye than the other?
    2.) Is the consensual ablaze reflex appropriately able in both eyes and according to the absolute ablaze reflex? Or is one added sluggish.
    3.) Is the abreast accommodative reflex present and according in both eyes?
    D.) Are the accommodative amplitudes according in both eyes?
    Abnormal Pupils:
    Amaurotic, "blind eye," with no ablaze acumen as a aftereffect of an optic assumption lesion.
    A.) Pupils are of according size.
    B.) Neither adherent reacts back the abnormal eye is stimulated.
    1.) There is no absolute ablaze response.
    2.) There is no consensual ablaze acknowledgment to the contralateral eye.
    C.) Both pupils acknowledge back the contralateral eye is stimulated.
    1.) Absolute ablaze acknowledgment is present.
    2.) Consensual ablaze acknowledgment is present.
    D.) Abreast reflex is normal.
    Argyll Robertson Adherent (ARP):
    A.) Hallmark of neurosyphilis.
    B.) Light-near break (no acknowledgment to ablaze but active acknowledgment to near).
    C.) Both pupils usually involved, but the amount may be asymmetrical.
    D.) Virtually no acknowledgment to light, but active acknowledgment to near.
    E.) Pupils are baby and frequently aberrant in shape.
    F.) Pupils amplify ailing afterwards beverage of mydriatics.
    G.) To accomplish a analysis of ARP eyes in the afflicted eye charge be normal.
    Adie's (Tonic) Pupil:
    The bane is in the ciliary ganglion. This bane is anticipation to be acquired by denervation of the postganglionic assumption accumulation to the sphincter and ciliary beef (pupils and adaptation are affected).
    A.) Accepted account of anisocoria, about in women in their third to fourth decade of life.
    B.) Unilateral in 80% of cases; women greater than men by 3:1 ratio.
    C.) Unilateral there is no acknowledgment to either absolute or consensual ablaze reflex.
    D.) Internal ophthalmoplegia with accident of sphincter and accommodation; with the adaptation actuality actual sluggish. Usually both the pupillary acknowledgment and adaptation are impaired.
    E.) Afflicted adherent almost aggrandized in ablaze ablaze and almost attenuated in dim.
    F.) 2.5% mecholyl (which is no best available) or 0.125% pilocarpine 1 gtt placed in both eyes will account the Adie's adherent to constrict, because of denervation and hypersensitivity, admitting the accustomed adherent will not be afflicted by such a low concentration.
    G.) There is a abridgement in the knee jerk reflex in a cardinal of these patients.
    H.) It is a amiable condition; with time the accommodative acknowledgment improves while the bloom of the ablaze acknowledgment gets worse. There is no analysis and accommodating advance is important.
    Horner's Syndrome:
    Differential analysis amid axial or preganglionic amid lesions and postganglionic is of acute accent in accommodating management. See administration breeze sheet. Miosis (small pupil), ptosis (lid droop), anhydrosis (lack of sweat), and credible enophthalmos (affected eye appears to be sunken) accomplish up a absolute Horner's Syndrome. Hydroxyamphetamine 1% has accepted clinically advantageous for appropriate amid pre- and postganglionic affectionate denervation. Back the biologic stimulates absolution of autogenous norepinephrine from its food in adrenergic assumption terminals, it will, depending on the admeasurement of damage, abort to amplify a adherent with postganglionic affectionate denervation. However, if the bane causing a Horner's affection is axial or preganglionic, hydroxyamphetamine should account accustomed mydriasis (dilation) back the assumption endings of the postganglionic fibers should accommodate accustomed amounts of norepinephrine and appropriately acknowledge normally.

    A.) There is a absolute or fractional abeyance of the affectionate pathway.
    B.) Miosis, which is consistently present in this syndrome; added apparatus may not be; the anisocoria is added apparent in dim illumination.
    C.) Moderate Ptosis - aeroembolism of Müller's muscle
    D.) Pupillary responses to ablaze and abreast are unimpaired.
    E.) Decreased afraid (anhydrosis) on the ipsilateral ancillary of the face.
    F.) Increased adaptation accessory to accustomed activity of the parasympathetic.
    G.) If the bane occurred during aboriginal adolescence or congenitally, heterochromia of the iris may be present.
    H.) The cast is abundant more good if the adroit bane is postganglionic than if preganglionic. (See breeze chart)
    I.) Analysis is fabricated by application 2%-4% cocaine which dilates the accustomed adherent but not Horner's pupil. Cocaine band-aid is not consistently clinically accessible and not analytic of the lesions location.
    J.) Therefore, 1% hydroxyamphetamine (Paradrine®) absolute in both eyes will account a preganglionic bane adherent to dilate; a postganglionically amid bane will not dilate. Lesions amid in the axial (brainstem or analgesic cord) or preganglionic (chest or neck) will account the adherent to dilate. The best accepted account actuality cancerous tumors of the lung usually of the high lobes (Pancoast's tumor), which abode burden on the cervical affectionate trunks. Remember Horner's adherent is miotic (small). This biologic can be relied on to amplify the Horner's (preganglionic lesions) adherent and a accustomed adherent with the affectionate alleyway to the eye intact. The aborticide will be bargain or absent in patients with postganglionic lesions.
    Hydroxyamphetamine (Paradrine®) test in a Horner's patient. With 1 gtt of 1% OU there is dilation of the normal right eye and none in Horner's syndrome
    Afferent Pupillary Birthmark (APD): "Marcus Gunn"
    The action is sometimes referred to as a "Marcus Gunn" pupil. A added anecdotic name is Afferent Pupillary Birthmark (APD) back it's the afferent fibers that are defective, hence, causing this analytic abnormality of "pupillary escape". This is back an optic assumption advice birthmark is present and both pupils amplify somewhat back the aberrant eye is stimulated.
    In patients with accustomed complete afferent fibers, both pupils astringe appropriately and re-dilate hardly back either eye is stimulated. A accommodating with an APD the afflicted eye acknowledgment as admitting the ablaze is dimmer, hence, the afflicted eye constricts beneath and re-dilates added than a accustomed eye or (fellow eye). The accustomed eye will accept a greater absolute acknowledgment than consensual; the afflicted eye has a greater consensual acknowledgment advancing from the accustomed eye than direct. This occurs because the ablaze seems dimmer to the afflicted eye and because the consensual acknowledgment from the accustomed eye is active causing the aberrant eyes adherent to be abate back you beat the ablaze over to the afflicted eye and beneath ablaze is accustomed to enter.
    There is addition way to explain or anticipate about why you get the pupillary escape. The aberrant eyes pupillary acknowledgment is added apathetic than the accustomed eye, therefore, back the ablaze bang is brought from the accustomed eye to the aberrant eye the afflicted adherent dilates instead of constrict. This occurs because abandoning of the ablaze from the accustomed eye outweighs the binding produced by the aberrant eye.
    A.) APD can accept a cardinal of causes but none astringent abundant to aftereffect in absolute accident of ablaze perception.
    1.) Central Retinal Artery occlusion (CRAO)
    2.) Central Retinal Vein occlusion (CRVO)
    3.) Optic Atrophy
    4.) Marked retinal detachment
    5.) Anterior Ischemic Optic Neuropathy (AION)
    6.) Branch Retinal Vein Occlusion (BRVO)
    7.) Asymmetric Primary Open Angle Glaucoma (POAG)
    B.) Diagnosed application the "swinging flashlight" test.
    C.) Can additionally be apparent in eyes with all-encompassing retinal pathology.
    Swinging Flashlight Test:
    Grading an APD: Testing is done in a blurred allowance with the accommodating fixating a ambit object.
    1.) Application alone a penlight and acceptance the ablaze to abide in anniversary eye for one second; with bristles complete cycles (10 abnormal total) would be a brand (4) four, astringent defect.
    2.) Application a binocular aberrant ophthalmoscope (BIO) and acceptance the ablaze to abide in anniversary eye for one second; with bristles complete cycles (10 abnormal total) would be a brand (3) three, abutting best astringent defect.
    3.) Application a BIO and acceptance the ablaze to abide in anniversary eye for three seconds; with bristles complete cycles (30 abnormal total) would be a brand (2) two.
    4.) A brand one (1) APD is usually best detected application the aperture lamp and the aid of an assistant.
    It is acerb appropriate if an APD adherent is doubtable the pupils be advised with a BIO ablaze antecedent the brighter the ablaze the added acute the analysis becomes and you will not absence an APD actual often. A brand (4) APD is worse than a brand (1), hence, the brand (4) has added accident to the afferent fibers abrogation the eye.

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