This document provides an examination outline for peripheral vascular disease and gangrene. It discusses examining the patient's history, performing a local examination of the affected area including inspection, palpation, and auscultation. The general examination involves assessing factors like the patient's age, sex, and any underlying conditions like atherosclerosis, Buerger's disease, Raynaud's disease, or diabetes that may have contributed to the vascular issues. Specific tests are outlined to evaluate symptoms, limb coloration, pulses, skin temperature, capillary and venous refill time, and to listen for bruits that could indicate problems like stenosis, aneurysms, or arteriovenous fistulas.
Examination of Swelling in a patient is always a task for MBBS students. This PPT provides the students, how to elicit a history & also the easy way to examine a swelling.
Case study on Varicose Veins & Venous UlcersAbhineet Dey
A clinically based study of a case of Varicose Veins & Venous Ulcers.
Moderator:
Dr M. K. Mazumdar
Asst. Professor,
Dept. of Obstetrics and Gynaecology,
Gauhati Medical College & Hospital
Presented by:
29: Abhineet Dey
30: Devasree Kalita
31: Parishmita Sharma
32: Samadrita Borkakoty
33: Ankur Jain
34: Dhurjyoti Nath
35: Mousumi Mehtaz
Students of 8th Semester,
Gauhati Medical College & Hospital, Guwahati, Assam
Examination of Swelling in a patient is always a task for MBBS students. This PPT provides the students, how to elicit a history & also the easy way to examine a swelling.
Case study on Varicose Veins & Venous UlcersAbhineet Dey
A clinically based study of a case of Varicose Veins & Venous Ulcers.
Moderator:
Dr M. K. Mazumdar
Asst. Professor,
Dept. of Obstetrics and Gynaecology,
Gauhati Medical College & Hospital
Presented by:
29: Abhineet Dey
30: Devasree Kalita
31: Parishmita Sharma
32: Samadrita Borkakoty
33: Ankur Jain
34: Dhurjyoti Nath
35: Mousumi Mehtaz
Students of 8th Semester,
Gauhati Medical College & Hospital, Guwahati, Assam
Venous ulcer is one of the commonest complication of varicose veins. It may also occur in a condition called post phlebitic limb which is a sequelae to acute deep vein thronbosis. Hurry in surgical treatment of this condition before the ulcer heals could lead to a failure. Good conservative treatment for healing of the ulcer followed by surgical intervention gives the best results.
Venous ulcer is one of the commonest complication of varicose veins. It may also occur in a condition called post phlebitic limb which is a sequelae to acute deep vein thronbosis. Hurry in surgical treatment of this condition before the ulcer heals could lead to a failure. Good conservative treatment for healing of the ulcer followed by surgical intervention gives the best results.
PHYSIOTHERAPY IN COMMON VASCULAR CONDITIONS.pptxKunjalPardeshi1
Vascular disease includes any condition that affects your circulatory system, or system of blood vessels. This ranges from diseases of your arteries, veins and lymph vessels to blood disorders that affect circulation.
Blood vessels are elastic-like tubes that carry blood to every part of your body. Blood vessels include:
Arteries that carry blood away from your heart.
Veins that return blood back to your heart.
Capillaries, your tiniest blood vessels, which link your small veins and arteries, deliver oxygen and nutrients to your tissues and take away their waste.
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. I'm barely responsible for compilation of various resources per my interest. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
Fluorescein angiography, fluorescent angiography, or fundus fluorescein angiography is a technique for examining the circulation of the retina and choroid using a fluorescent dye and a specialized angiographic camera.
Made by Ranjith R Thampi. A surgery powerpoint I made during internship for Management of Varicose Veins. Tried to cover as much as possible on the topic. Kindly comment before you download. Thanks!
A lumbar puncture (also called a spinal tap) is a procedure to collect and look at the fluid (cerebrospinal fluid, or CSF) surrounding the brain and spinal cord. During a lumbar puncture, a needle is carefully inserted into the spinal canal low in the back (lumbar area). Samples of CSF are collected.
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
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
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.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
2. Page 2
Out line…
• HISTORY
• PHYSICAL EXAMINATION
• LOCAL EXAMINATION
o ISPECTION
o PALPATION
o AUSCULTATION
• GENERAL EXAMINATION
3. Page 3
Age & sex
Atherosclerosis – disease of old age,
men > women
Buerger’s disease – men 20-40 yrs.
Raynaud’s disease – young women.
Diabetic arteriopathy – middle age.
4. Page 4
Limbs affected:
Buerger’s disease & atherosclerotic ischaemia –
lower limbs
Raynaud’s disease – upper limbs.
Bilateral or Unilateral:
• Buerger’s & Raynaud’s – bilateral
• Atherosclerotic gangrene – unilateral bilateral
• Gangrene due to embolism – unilateral.
• Diabetic gangrene – uni or bilateral.
5. Page 5
Mode of onset:
• Gangrene due to atherosclerosis, Buerger’s disease
and Raynaud’s disease occur spontaneously and
gradually.
• Embolic gangrene – suddenly with severe pain.
8. Page 8
Site of pain level of arterial occlu
In foot - lower tibial or plantar arteries
In calf - femoro-popliteal jn.
In thigh - opening of sup.femoral artery
In buttock - bifurcation of common iliac -
artery or the aorta.
9. Page 9
Claudication distance: The patient complains
after
walking a distance, pain starts.
Boyd’s classification:
Grade-I sometimes if the patient continues to
walk pain disappears.
Grade-II pain continues & patient can still
walk
with effort.
Grade-III pain compels the patient to take rest
10. Page 10
EFFECTS OF HEAT AND COLD:
These are attacks repeated till the end patches
of sup.ulceration and gangrene appear at the
finger tips- LOCAL GANGRENE
12. Page 12
Paresthesia – numbness,pins & needles and
other types of paresthesia in the skin of the foot.
Due to- shunting of blood from skin to muscles.
H/O superficial phlebitis – swelling, redness and
minor pain in the affected part.
Involvemet of other arteries.
15. Page 15
1. CHANGE IN COLOUR1. CHANGE IN COLOUR
• Marked pallor – sudden arterial obstruction.
in embolism or Raynaud’s disease
• Congestion and purple blue cyanosed – severe
ischaemia and pregangrenous stage
16. Page 16
• Thinning of skin
• Diminished growth of hair
• Loss of subcutaneous fat
• Shininess
• Trophic changes in nails –
brittle & transverse ridges
17. Page 17
3. BUERGER’S POSTURAL TEST:3. BUERGER’S POSTURAL TEST:
PROCEDURE:
The patient lies on his back, and asked
to raise his legs one after the other
keeping the knees straight.
The legs of normal individual remain
pink even if they are raised to 90˚.
But in case of ischaemic limb elevation to
a certain degree will cause marked pallor
and the veins will be empty and
guttered.
Buerger’s angle or Vascular angle.
<30˚ - severe ischaemia
If not pallor – occlusive arterial disease is
18. Page 18
4. CAPILLARY FILLING TIME:4. CAPILLARY FILLING TIME:
• After elevating the legs, the patient is asked
to sit up and hang his legs down by the side
of the table.
• A normal leg will remain pink as it was during
elevated position.
• But in ischaemic leg will first become pallor
when elevated & gradually become pink in
horizontal position.
• The change of colour takes place slowly and is
called CAPILLARY FILLING TIME.
19. Page 19
5. VENOUS REFILLING:5. VENOUS REFILLING:
•After keeping the limb elevated for a while if
it is then laid flat on the bed, there will be
normal refilling of the veins within 5 sec.
•But in ischaemic limb it will be delayed.
•If a normal limb is raised to about 90˚ there
will be gradual collapse or guttering of the
veins.
•But in ischaemic limb the veins are seen
collapsed either in horizontal position or as
soon as it is lifted to even 10˚.
20. Page 20
IN ESTABLISHED GANGRENE,IN ESTABLISHED GANGRENE,
The following are noted…….
1.Extent and colour
2. type – dry or wet
3.Line of demarcation
4.Observe limb above the gangrenous area.
21. Page 21
PALPATIONPALPATION
1. Skin temperature
2. Capillary refilling
3. Venous refilling
4. Crossing leg test (Fuchsig’s test)
5. Cold and warm water test.
6. Elevated arms test.
7. Allen’s test
8. Branham’s Sign
9. Costoclavicular compressive manoeuvre
10.Hyperabduction manoeuvre
11.Gangrenous area.
12.Crepitus
13.Palpation of the blood vessels.
22. Page 22
1. SKIN TEMPERATURE:1. SKIN TEMPERATURE:
Best felt with back of fingers
Compare the 2 limbs, & feel whole of the limb
2. CAPILLARY REFILLING:2. CAPILLARY REFILLING:
3. VENOUS REFILLING:3. VENOUS REFILLING:
the capillary blood flow time is
Longer in ischaemic limb.
Poor in ischamic limb and increased
in arteriovenous fistula.
This is known as HARVEY’S SIGN
23. Page 23
CROSSED LEG TEST (Fuchsig’s testCROSSED LEG TEST (Fuchsig’s test
• To detect popliteal pulsation.
• The patient is asked to sit with the legs
crossed one above the other so that the
popliteal fossa of one leg will lie against
the knee of other leg.
• The crossed leg will show oscillatory
movements of the foot which occur
synchronously with the pulse of popliteal
artery.
• If popliteal artery is blocked, this
oscillatory movement will be absent.
24. Page 24
To provoke arteriospasm in Raynaud’s disease
The patient asked to put hand in…..
• Ice water – hand becomes white.
• Warm water - hand become blue
due to cyanotic congestion.
25. Page 25
6. ELEVATED ARMS TEST:6. ELEVATED ARMS TEST:
Performed when thoracic outlet syndrome is
suspected.
PROCEDURE:The patient is asked
to abduct his shoulders to 90˚
and at the same time upper limbs
are externally rotated fully.
Now patient is instructed to open
and close his hands for a period
of 5 min.
A normal individual can perform without difficulty.
Patient will complain of tingling and numbness in
the fingers.
26. Page 26
7. ALLEN’S TEST:7. ALLEN’S TEST:
To know patency of radial and ulnar arteries.
The patient is asked to clench his fist tightly.
The surgeon presses on the ulnar and radial
arteries at the wrist.
Now pressure is removed and colour of the
hand is noted.
If any artery is blocked the colour remains white,
if patent the palm assumes normal colour.
28. Page 28
8. BRANHAM’S SIGN:8. BRANHAM’S SIGN:
This is performed when arteriovenous fistula is
suspected.
A pressure on the artery proximal to the fistula
will cause reduction in the size of swelling,
disappearance of bruit, fall in PR.
29. Page 29
9. Costoclavicular compressive9. Costoclavicular compressive
manoeuvre or test:manoeuvre or test:
Pateint’s radial pulse is felt.
The patient throws shoulders backwards &
downwards.
This will compress the subclavian artery between
clavicle and the first rib leading to reduction or
disappearance of radial pulse.
30. Page 30
10. Hyperabduction manoeuvre
11. Gangrenous area – dry or wet.
12. Crepitus
13. Limb above the gangrenous
area
Pectoralis minor syndrome
31. Page 31
Most important part of examination of ischaemic
limb.
Disappearing pulse- sign of unmasking the
preliminary stage of arterial occlusion.
Expansile arterial pulse – aneurysm.
Embolus in artery – firm & tender.
32. Page 32
The following arteries are to be examined:
1. Dorsalis pedis artery
2. Posterior tibial artery
3. Anterior tibial artery
4. Popliteal artery
5. Femoral artery
6. Radial and Ulnar arteries
7. Brachial artery
8. Subclavian artery
9. Common carotid artery
10. Superficial temporal artery
39. Page 39
ADSON’S TEST:ADSON’S TEST:
+ in the presence of cervical rib and scalenus
anticus syndrome due to compression of the
subclavian artery.
40. Page 40
AUSCULTATIONAUSCULTATION
Listen along the course of all major arteries
Systolic bruit over an artery – turbulent bloodflow
beyond the stenosis
Systolic murmor – aneurysm.
Continuous machinary murmor – arteriovenous
fistula
Blood pressure of both arms are measured.
Reactive hyperaemia test – to know severity of
arterial ischaemia.
41. Page 41
GENERAL EXAMINATIONGENERAL EXAMINATION
1. Atherosclerosis – examined thoroughly to
exclude IHD, CVD, HTN, renal artery stenosis etc.
2. In embolic manifestation, the heart is examined
for presence of cardiac murmor
3. Diabetes is often accompanied by
atherosclerosis.
4. Peptic ulcer is sometimes accompanied with
these diseases.