This document provides an overview of imaging techniques used in the evaluation of thoracic trauma. It begins with an introduction to the epidemiology of thoracic injuries and the importance of rapid diagnosis. The initial assessment involves a primary and secondary survey with a focus on airway, breathing and circulation. The imaging survey typically begins with a portable chest x-ray to evaluate for pneumothorax, hemothorax and other injuries followed by an ultrasound to assess for pericardial effusion. Additional sections discuss specific injuries like flail chest, hemothorax and tension pneumothorax that may be seen on CXR. The role of CT in thoracic trauma evaluation is also reviewed.
General suggestions in ordering body CT in ED; vascular occlusion; aneurysm/pseudoaneurysm; bleeding and active contrast extravasation; extraluminal air
Description of various ultrasound features of benign and suspicious thyroid nodules with multiple ultrasound systems for risk stratification of malignancy.
Outlines of the presentation
- How to read a brain CT
- Gross CT brain anatomy
- Traumatic brain injury
- Ischemic and hemorrhagic strokes
- Type of intracranial hemorrhages
General suggestions in ordering body CT in ED; vascular occlusion; aneurysm/pseudoaneurysm; bleeding and active contrast extravasation; extraluminal air
Description of various ultrasound features of benign and suspicious thyroid nodules with multiple ultrasound systems for risk stratification of malignancy.
Outlines of the presentation
- How to read a brain CT
- Gross CT brain anatomy
- Traumatic brain injury
- Ischemic and hemorrhagic strokes
- Type of intracranial hemorrhages
Summary and illustrations of various traumatic brain injury including primary and secondary lesions as well as limited information on indications of brain imaging in trauma
Five pearls and pitfalls in using head CT for diagnosis of traumatic brain injury. This was presented at the 51st Annual Scientific Meeting of the Royal College of Radiologists of Thailand (6 Aug 2014)
Transverse Aortic Constriction: The Importance of Monitoring Surgical OutcomesScintica Instrumentation
This free webinar hosted by Scintica Instrumentation reviewed with the viewer the importance of monitoring their surgical outcomes, specifically following transverse aortic constriction (TAC)
Join Tonya Coulthard as she discussed some background information about the TAC surgery, variability in the surgical outcomes and how to monitor those, as well as the importance of stratifying animals based on severity of constriction prior to initiating any form of intervention.
View more here https://www.scintica.com/webinar-transverse-aortic-constriction-the-importance-of-monitoring-surgical-outcomes/
LUC ROTENBERG, GREGORY LENCZNER, ULTRASOUND GUIDED VENOUS ACCESS CHEST PORT IMPLANTATION, SUBCLAVIAN ACCESS, NO TUNELISATION, DELTOPECTORAL GROOVE INCISION AND ACCESS , TIP POSITION XRAY CONTROL
Practical Points in Emergency CT for Emergency PhysiciansRathachai Kaewlai
The handout describes some brief practical points on emergency CT, particularly for emergency physicians. They include imaging utilisation trends, radiation dose, contrast reaction, contrast-induced nephropathy, use of oral contrast medium and some caveats on emergency CT (esp. abdomen)
A slideshow of 'Imaging of Head Trauma: Part I' describes nature, mechanism, significance of head trauma, indications and choices of imaging in patients with head trauma, and normal anatomy of the brain with emphasis on CT.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
2. www.RiTradiology.com
www.RiTradiology.com
Introduction
• Trauma leading cause of death in
developing countries | 4th in first-world
countries
• Loss of productive years of life – because
most occur in young individuals
• Traffic accidents, falls, recreational,
violence
• Rapid diagnosis important to avoid
morbidity and mortality
3. www.RiTradiology.com
www.RiTradiology.com
Introduction
• Thoracic injuries
– 10-15% of all trauma
– 25% of trauma fatalities
• Blunt (70-80%) > penetrating
– Compression thoracic wall injuries
– High velocity injury visceral injuries
• Rx mostly conservative. Thoracotomy rate...
– <10% in blunt thoracic trauma
– 15-30% in penetrating thoracic trauma
Image from http://www.veomed.com/va041842172010
13. www.RiTradiology.com
www.RiTradiology.com
Flail Chest
• Most significant chest wall injuries
• Paradoxical movement of a segment
of chest wall
• Problems of underlying lung contusion
and pain leading to hypoxia
• 3 or more contiguous segmental rib
fractures
• Variations include anterior flail,
posterior flail and flail including
sternum
• CXR may not show all fractures, esp
anterior and lateral fractures
Images from wikipedia
15. www.RiTradiology.com
www.RiTradiology.com
Hemothorax
• Blood in pleural space
• Source: chest wall, lung
parenchyma, heart or great vessels
• Chest wall injuries can cause
bleeding from intercostal and IMA
• As much as 1,000 mL of blood may
be missed when viewing portable
supine CXR (400-500 mL required
for blunt CP angle on upright CXR)
• Massive hemothorax
– >1,500 mL of blood or
– > 1/3 of blood volume
Supine CXR: apical capping, lateral
extrapleural density
16. www.RiTradiology.com
www.RiTradiology.com
Trauma Ultrasound: FAST
• FAST includes pericardial and pleural
spaces evaluation
• Fluid in acute trauma = blood until proven
otherwise
• Straightforward, “Yes/No” answer
• Pericardial evaluation is very important
and should be the first part of all FAST
scans, esp. penetrating trauma
17. www.RiTradiology.com
www.RiTradiology.com
Pericardial Evaluation
• Presence of pericardial fluid
• Source of blood
– Great vessels
– Heart
– Pericardial vessels
• Tamponade physiology?
– Collapsed right heart chambers: right atrium – sensitive,
right ventricle - specific
– Distended IVC (caval index = 1)
• Key elements of tamponade
– Rate of fluid accumulation
– Effectiveness of compensatory mechanisms
Nypemergency.org
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Detection of Pneumothorax
• Pneumothorax occult on CXR in 29-72%
• EFAST can identify pneumothorax before CXR
• Identify contiguity of visceral and parietal pleura
using simple US signs
– To exclude pneumothorax
– Extended FAST (EFAST)
– Normal = lung sliding (B), seashore sign (M mode)
– Abnormal = loss of lung sliding (B), stratosphere (M),
lung point (B & M)
25. www.RiTradiology.com
www.RiTradiology.com
Pneumothorax:
A line sign
• Seeing A-line with loss of
lung sliding suspect
pneumothorax
• One B-line can R/O
pneumothorax where
probe is applied
Lung point
• Most specific sign
• At border between
aerated lung and ptx,
there is intermittent
appearance of lung
sliding during inspiration/
expiration
27. www.RiTradiology.com
www.RiTradiology.com
Detection of Pneumothorax
• Absent lung sliding
– Sensitivity 100%, specificity 78%
• Absent lung sliding + A line sign
– Sensitivity 95%, specificity 94%
• Lung point
– Specificity 100%
• EFAST more sensitive than portable CXR
trauma
Lichtenstein DA et al. Crit Care Med 2005
28. www.RiTradiology.com
www.RiTradiology.com
Pitfalls of US on Pneumothorax
• “Loss of lung sliding” alone is not specific
for pneumothorax
– Pleural adhesion/thickening
– Atelectasis
– Lobec/pneumonectomy
– One-lung intubation
• Look for “Lung Point”
• Comparison with contralateral lung
29. www.RiTradiology.com
www.RiTradiology.com
CT in Thoracic Trauma
• Role of CT used to be for R/O thoracic
aortic injury
• Now CT believed to be most accurate for
diagnosis several thoracic trauma
• Yield of CT is higher when done after an
abnormal initial CXR or performed
selectively based on clinical criteria
31. www.RiTradiology.com
www.RiTradiology.com
CT Technique
• Helical mode
• Thinnest collimation possible and reformatted
to 2-2.5 mm for viewing
• 120 kV
• Automatic tube current modulation
• No plain scan
• Late arterial phase + delays at site of
vascular injuries
• Routine coronal and sagittal reformations
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www.RiTradiology.com
What Else We Are Looking For?
• ABC’s of Jud W. Gurney (chestx-ray.com)
– Systematic evaluation of blunt thoracic trauma
– A, B, C, D, E, F, G, H, I
• Missed diagnosis
– 4% died within 24 hours
– 30% missed interpreted
• Aortic injury
• Diaphragmatic trauma
• Flail chest
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Aortic Injury (TAI)
• 16% MVA fatalities
• 85-90% mortality prior to reaching hospital
– Survivors
• 30% died within 6 hours
• 50% died within 24 hours
• 72% died within 8 days
• 90% died within 4 months
uvahealth.com
37. www.RiTradiology.com
www.RiTradiology.com
Aortic Injury (TAI)
CXR Signs of TAI
Mediastinal widening (>8 cm at aortic
arch level, or by visual assessment)
Loss of AP window, descending T-aorta
Tracheal shift to the right of T4 SP
NG tube displacement to the right
Widened paraspinal or right paratracheal
stripes
Left apical pleural cap sign
Normal (10-15%)
For CXR: PPV 10%, NPV 98%
but TAI is life-threatening, keep low threshold for CT
X-ray signs are related to
mediastinal hematoma
>8 cm
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www.RiTradiology.com
Aortic Injury (TAI)
• Indirect CT signs
– Periaortic hematoma
• Direct CT signs
– Pseudoaneurysm
– Intimal flap
– Intimal irregularity
– Pseudocoarctation
– Extravasation
• Term “traumatic dissection” is discouraged (confusing
with aortic dissection related to hypertension)
Pseudoaneurysm and periaortic hematoma
40. www.RiTradiology.com
www.RiTradiology.com
Aortic Injury (TAI)
• Periaortic mediastinal hematoma
– Small veins in area of injury or vasa vasorum
– Does not arise directly from aorta tear
– Usually adjacent to aoric arch and prox descending
aorta, but may tracts down descending aorta to
diaphragm (retrocrural)
Retrocrural hematoma seen on
abdominal CT without clear
etiology (ie, spine fracture)
should raise a concern for TAI
41. www.RiTradiology.com
www.RiTradiology.com
Aortic Injury (TAI)
• Transesophageal echocardiography (TEE)
– Heart (for contusion) and t-aorta
– More invasive than CT and usu requires sedation
– Blind spots: arch, arch vessels, distal ascending aorta
– May be used intraoperatively
• Catheter aortography
– Prior gold standard, now reserved for selected cases
and for endovascular Rx
43. www.RiTradiology.com
www.RiTradiology.com
(Tracheo)Bronchial Injury
• Traumatic pneumomediastinum: must exclude
– Airways injuries (larynx, tracheobronchus)
– Esophageal injuries
• Bronchoscopy gold
standard
• However, most are benign
– Extension of pneumothorax
through pleural tear
– Pulmonary alveolar rupture
“Macklin effect”
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www.RiTradiology.com
Cord Injury
• 25% spine fractures
• 90% neurologic injury
• Most common site = T9-11
– Critical zone
– Transition of facet joint orientation: T facets face
inward, L facets face outward
• Difficult assessment on trauma CXR
– Portable technique
– Rule of 2’s
Thoracic spine fractures often
causes spinal cord injury
because cord is large in
relation to the canal
Image from superhuman.net.au
45. www.RiTradiology.com
www.RiTradiology.com
• On AP view, look at pedicles and spinous
processes
• Everything no more than 2 mm from one level to
the next
– Interspinous space
– Interpedicular distance
• Elevated paravertebral stripes
– Also sign of TAI
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www.RiTradiology.com
Flail Chest
Rib fractures
• Most common findings after blunt
chest trauma
• CXR sensitivity 18-50%
• Most common = rib 4-9
– Rib 1-3 neurovascular injury
– Rib 9-12 liver, spleen, kidney
• Absence of fracture lines:
– In adults >65 years may warrant rib series.
– In children, it does not mean mild injuries because of
pliable ribs