Clinical surface anatomy - Dafydd Loughran
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1. The document provides guidance on surface anatomy and procedures. It prompts the learner to draw various anatomical structures and landmarks. 2. Scenarios describe emergency situations requiring the learner to identify injuries, diagnoses, and appropriate procedures. They are quizzed on related anatomy. 3. Key anatomical structures, landmarks, and procedures covered include the larynx, trachea, jugular vein access, chest drains, abdominal organs, hernias, lumbar puncture, and fascia iliaca block.
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The three main layers of muscles in each intercostal space from superficial to deep are the external intercostal, internal intercostal, and innermost intercostal. The external intercostals elevate the ribs during inspiration, while the internal and innermost intercostals depress the ribs during expiration. Each intercostal space contains an artery, vein, and nerve, known as the intercostal vessels and nerve. The intercostal arteries and veins accompany the intercostal nerves and follow a ventral artery, vein, nerve pattern.
brachial plexus final.pptx
The brachial plexus is formed by the ventral rami of cervical and thoracic nerve roots. It divides into trunks, cords and branches that innervate the muscles and skin of the upper limb. Injuries to different parts of the brachial plexus result in characteristic patterns of muscle weakness and sensory loss. Erb's palsy involves the upper trunk and causes weakness of shoulder muscles. Klumpke's palsy involves the lower trunk, affecting hand muscles. Specific nerves like the radial and median nerves can also be injured.
Contracted pelvis
This document provides information on the normal female pelvis and contracted pelvis. It describes the boundaries, diameters, and planes of the true and false pelvis as well as the pelvic inlet, cavity, and outlet. It discusses anatomical landmarks like the sacral promontory, pubic bones, and ischial spines. Common causes of a contracted pelvis like rickets are mentioned. The Caldwell-Moloy classification system divides pelves into gynecoid, anthropoid, android, and platypelloid types based on transverse diameters.
The Thoracic cage Anatomy.pptx
To describe the structure of the thorax, cutaneous innervations of thorax (concept of the myotomes and dermatomes) and of bony framework that forms part of the thorax, and how it is adapted to their functions
To define the thorax, rib cage and thoracic wall.
To describe the structures that form the boundary of the rib cage i.e ribs, sternum, vertebrae.
To outline the clinical importance of the structures that form the rib cage.
How to perform heart auscultation: do minimum, hear everything
So, here you are with stethoscope in your hands facing your first patient. Or maybe not the first?
Auscultation has to be performed quickly but without any omissions. One more time: quickly and comprehensively.
The rest is in the slideshow.
More information about heart auscultation and cardiological diagnosis: http://cardiacauscultation.com
Brachium to hand musculature
This document describes the muscles of the brachium (arm), antebrachium (forearm), and hand regions. It provides details on the origin, insertion, action, blood supply, and nerve innervation of each muscle. Key muscles described include the biceps brachii, triceps brachii, flexor digitorum profundus, and extensor digitorum in the forearm, as well as the abductor pollicis brevis and flexor pollicis brevis in the hand.
Paravertebral Cevical Sympathetic Block
The document discusses paravertebral cervical sympathetic block, including:
- Its history dating back to 1905-1910 with further developments in the 1920s and 1930s.
- Applied anatomy of the sympathetic chain and ganglia in the cervical region, including the stellate ganglion.
- Indications for stellate ganglion block such as CRPS, ischemic diseases, and hyperhidrosis.
- Techniques for the block including the anterior paratracheal approach using local anesthetic.
- Potential side effects include Horner's syndrome and diffusion of the local anesthetic to nearby nerves.
USMLE MSK L013 Upper 02 Muscles of scapular, pectoral and deltoid regions.pdf
The muscles in the scapular, deltoid, and pectoral regions play a crucial role in the movements and stability of the shoulder complex.
These muscles work in coordination to provide stability to the scapula, enable a wide range of shoulder movements, and contribute to the overall function of the upper limb.
Proper functioning of these muscles is essential for activities involving the shoulder complex, such as reaching, lifting, and throwing.
Brachial plexus injury
Upper plexus injury, <6 months: Spinal accessory nerve to suprascapular nerve via sural graft to restore shoulder function. Phrenic nerve to suprascapular or musculocutaneous nerve via graft to restore elbow flexion. Intercostal nerves to musculocutaneous nerve via graft. Contralateral C7 via graft to median nerve.
Complete lower plexus injury, <6 months: Spinal accessory nerve or intercostal nerves to musculocutaneous nerve via graft for elbow flexion. Nerve transfers aim to restore shoulder, elbow, hand, and finger function within 6 months to reinnervate muscles/nerves. Surgery for incomplete injuries depends on prognosis
Brachial plexus block new
The document discusses brachial plexus block techniques and reviews relevant anatomy, history, approaches, and complications. It provides an overview of the brachial plexus anatomy and different block techniques like interscalene, supraclavicular, infraclavicular, and axillary blocks. Complications discussed include nerve injuries from mechanical trauma, ischemia, or chemical toxicity from local anesthetics. Proper technique and drug administration are important to minimize risks.
Supracondylar Fracture.pptx
This document provides information on supracondylar humerus fractures in children. It describes the anatomy of the distal humerus that makes these fractures common. The typical mechanism of injury is a fall onto an outstretched hand, causing hyperextension of the elbow. Complications can include vascular injury, nerve palsy, and ipsilateral radius fracture. Treatment involves closed or open reduction based on the fracture classification and presence of complications. Pinning techniques are described to stabilize the reduction. Potential postoperative complications are also outlined.
Radial nerve entrapment
1. The radial nerve is a major branch of the brachial plexus that provides motor innervation to muscles of the posterior arm and extensor compartment of the forearm.
2. It is susceptible to entrapment at several points along its course, most commonly in the radial tunnel where the posterior interosseous nerve passes.
3. Radial nerve entrapment causes weakness of wrist and finger extension and can be diagnosed through history, physical exam including Tinel's sign, and electrodiagnostic testing. Conservative treatment includes splinting and steroid injections while surgery involves nerve decompression.
Thoracic outlet syndrome-1.pptx
Thoracic outlet syndrome refers to compression of the brachial plexus and subclavian vessels at the thoracic outlet. It has several potential causes including abnormalities of the first rib, scalene muscles, clavicle, and pectoralis minor muscle. Symptoms can be neurogenic like pain, paresthesia and muscle atrophy, or vascular such as coldness, weakness and arterial insufficiency. Diagnosis involves physical exam, imaging, and nerve conduction studies. Treatment ranges from conservative physiotherapy to surgical resection of compressive structures like the first rib via various approaches depending on the type and severity of thoracic outlet syndrome.
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2) Early recognition of at-risk individuals and risk assessment using tools like Braden or Norton scales are important for prevention. Risks include factors like impaired mobility, nutrition, illness.
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The Reconstructive Ladder - Mussa Mensa
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This document provides information on small bowel obstruction including:
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Nsaids and GORD - Julie Cornish
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2) NSAID use is associated with an increased risk of upper GI symptoms, peptic ulcers, and complications like bleeding. Risk factors for ulcers and complications include age over 60, previous ulcer history, concomitant use of aspirin or corticosteroids, and NSAID-associated dyspepsia.
3) While COX-2 selective
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1. The key presentations discussed are dysphagia, pancreatitis, and gallstone disease. For a case of dysphagia, oesophagogastroscopy is the most appropriate initial investigation to obtain a biopsy.
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This document discusses the management of general surgery emergencies in childhood and adolescence. It covers topics such as managing patients presenting with abdominal pain, acute scrotal conditions like testicular torsion, and hernias. Specific conditions discussed in more detail include undescended testes, intussusception, hypertrophic pyloric stenosis, and vomiting in children. For each topic, it provides guidance on diagnosis, initial management, indications for referral or surgery, and expected outcomes. The goal is to equip trainees with the knowledge to competently handle common pediatric general surgical emergencies.
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Wrist fractures - Dafydd Loughran
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2) It describes mnemonics to remember carpal bone names and locations of major nerves.
3) Examples of common fracture types are given like Colles', Smith's, Barton's and scaphoid fractures along with their characteristic features and management approaches.
4) The document stresses following ATLS protocols, considering associated injuries, and being vigilant for compartment syndrome in the assessment and initial stabilization of fractures.
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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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Clinical surface anatomy - Dafydd Loughran
- 2. *Cover RELEVANT surface anatomy for surgical & medical procedures & presentations *Interactive, drawing on each other! *Scenario based
- 3. *Big collision ahead, car vs car, 70mph *1st on scene *23yr male driver *Obvious facial #s. Gross distortion of lower face. *GCS8/15. Stridor then quiet & unable to breath. *Chin lift – no improvement *What are you going to do…?
- 4. Cricothyroidotomy – pen, ventflon - Cricothyroid membrane Tracheostomy – 2/3 tracheal rings Draw: *Laryngeal prominence of thyroid cartilage *Cricoid cartilage *Cricothyrotomy placement *Thyroid gland
- 5. *It’s your first central line insertion. *Your boss has asked for a jugular line insertion *What’s the anatomy?
- 6. Draw: *Anterior triangle – midline, anterior sternocleidomastoid, mandible *Posterior triangle – clavicle, post border sternocleidomastoid, ant border trapezium Internal Jugular central line: Done under US guidance. Imagine your pen is the needle. Locate both sternal & clavicular heads of sternocleidomastoid. Choose your spot. Carotid artery is medial - pulsatile
- 7. *Airway now fixed! *Increasingly SOB. *Trachea deviated to Left. Reduced Right expansion. Hyper-resonant Right side. *RR35, SpO2 82% *Diagnosis? *What are you going to do? *What’s the anatomy?
- 8. *Sternal angle (of Louis) – lower than often thought *Intercostal space below *Mid-clavicular line Mark out angle & 2nd rib Draw your spot & save a life!
- 9. *Definitive management? *Chest drain anatomy? & in relation to rib? *Triangle of safety Draw the triangle & pick a spot!
- 10. *18yr Female. *Fighting in town. Other girl’s protective boyfriend stabs her in the upper abdomen… *What’s at risk? *Where are those organs?
- 11. *Draw the 9 regions *Upper transverse line = Transpyloric plane (L1) *Hands breadth below xiphoid process. Draw: pancreas, stomach, duodenum, liver, & spleen
- 12. Just below nipples bilaterally! Base of Right costal margin Hiding under Left 9-11th ribs At risk especially with blunt trauma Spleen Transpyloric plane (L1) Tail & Body of pancreas Pylorus of stomach 2nd part of duodenum Superior mesenteric artery
- 13. *Lumbar puncture, Reg asks you to “crack on”… *Where are you aiming for? *What level, why, and how to find it? *Work your way up & draw the kidneys
- 14. *60yr old male. Noticed lump in groin for last few days. *No obstructive symptoms. *Cough impulse present *What will help you get to a diagnosis? Pubic tubercle Pubic symphysis ASIS Mid inguinal point = ASIS to PS. Femoral artery Mid point of inguinal ligament = ASIS to PT. Deep inguinal ring Identify on yourself:
- 15. *Inguinal vs Femoral - *Direct vs Indirect - Deep ring - Indirect Hasselbach’s triangle - Direct (weakness of abdominal wall) Superficial ring Above & Medial to PT = Inguinal Below & Lateral to PT = Femoral Controlled at Deep ring (mid-point of inguinal ring) = Indirect hernia
- 16. *90yr female *Intertrochanteric NOF # overnight *NOF pathway states Fascia-Iliaca block to be done by F1 *A&E sister kindly reminds you the last one your colleague did punctured the femoral artery. (I was told exactly this!) *What’s the anatomy? Where will you inject?
- 18. 1. Point out where you’d perform a needle cricothyrotomy. 2. What are the boundaries of the posterior triangle? 3. What are the boundaries of the triangle of safety? 4. Chest drain – will you go above or below the rib? 5. What nerve is at risk during chest drain insertion?
- 19. 6. Show the boundaries of the liver. 7. How do you find the position for a lumbar puncture? What spinal level is this? 8. How to differentiate between a direct or indirect hernia? 9. What lies at the mid-inguinal point? 10. What’s the anatomical landmark for a fascia iliaca block?
- 20. Any questions? Any surgical topics would you like covered before you finish the job?