Fon ortho final copy
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A 23-year-old Thai man was in a motorcycle accident where he crashed into the back of a pickup truck. He has pain in his left arm and abrasions on his left knee. On examination, he has a deformity and laceration on his left arm with limited range of motion. Imaging shows an open fracture of the left humeral shaft. The diagnosis is an open fracture of the left humeral shaft, which will be treated with debridement and plating and screws in the operating room.
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Extern conference teechaya ortho pdf
1. A 54-year-old Thai man presented with a closed fracture of the left midshaft tibia after a motorcycle accident where he collided with a pickup truck 2 hours prior.
2. Physical examination revealed a well-oriented man with a 3 cm abrasion on his left cheek, but otherwise normal vital signs. Neurological examination was normal except for tenderness and deformity in the left leg.
3. X-rays of the left leg and ankle showed a complete oblique fracture of the left midshaft tibia with soft tissue swelling but no displacement of fragments.
General anesthesia & obstetrics part III
→ Discuss indications of general anesthesia for operative delivery
→ Explain aspiration risk for general anesthesia in pregnancy and prevention strategy
Outline anaesthesia plan of care for induction, maintenance and emergency
Describe effect of volatile anaesthetics on uterine blood flow and tone
Discuss intraoperative strategies to prevent postoperative nausea and vomiting
Discuss other complications of general anaesthesia and clinical management
Rapid intubation
Rapid intubation, also known as rapid sequence intubation (RSI), is an emergency airway management technique used to quickly place an endotracheal tube. It involves preoxygenating the patient, administering induction medications to cause unconsciousness followed immediately by paralysis medications. This allows intubation to be performed without having to manually ventilate the patient first. Proper patient positioning, preparation of equipment, and verification of tube placement are important steps in the technique. Potential complications include esophageal intubation, hypotension, and dental trauma. RSI is the preferred method in emergency situations where immediate airway control is needed.
病房插管小筆記 (Note about Rapid sequence intubation)
The document discusses various aspects of intubation including:
1) Factors to consider when determining if and when to intubate a patient such as inability to maintain airway, respiratory insufficiency, and expected clinical course.
2) The "7 Ps of Rapid Sequence Intubation" process including preparation, preoxygenation, pretreatment, paralysis/induction, positioning, passing the tube, and post-intubation care.
3) Details of drugs commonly used for intubation like etomidate, propofol, midazolam, ketamine, succinylcholine, and rocuronium.
Rapid sequence intubation
Rapid sequence intubation involves several key steps:
1. Preoxygenation of the patient with 100% oxygen for 3 minutes to establish an oxygen reserve before intubation.
2. Administration of sedatives and neuromuscular blocking agents (NMBAs) to gain control of the airway without risk of aspiration.
3. Placement of the endotracheal tube once paralysis is achieved, confirmed by lack of muscle tone and ability to ventilate if oxygen saturation drops below 90%.
4. Postintubation management including chest x-ray, use of long-acting NMBAs, and sedation to facilitate mechanical ventilation.
Discharge criteria of patient What oral surgeon should know
Discharge criteria of patient What oral surgeon should knowDR ISHRAT UL EBAD INSTITUTE OF ORAL HEALTH SCIENCES DIKIOHS
1) Determining when a patient can safely be discharged after sedation or anesthesia is challenging and should involve objective criteria like standardized scales.
2) Common scales used include PADSS, Modified Aldrete Score, and Ped-PADSS which evaluate factors like consciousness, ventilation, oxygenation, circulation, and pain control.
3) Discharge criteria also considers bleeding control, nausea/vomiting prevention, review of postoperative instructions, and follow up care for special populations like diabetics and those with sleep apnea.Rapid Sequence Intubation (RSI)
RSI is a method of intubating patients who have a gag reflex who would otherwise be difficult to intubate. Intubation is accomplished by sedating and paralyzing the patient, allowing for easier intubation.
Rapid sequence intubation in ED
Rapid sequence intubation (RSI) involves the simultaneous administration of an induction agent and neuromuscular blocking drug to facilitate endotracheal intubation. It allows for increased success rates, decreased intubation times, and reduced risks of aspiration, hypoxia, and trauma. The key steps of RSI are preparation, preoxygenation, pretreatment, paralysis with induction, positioning, placement with proof of tube position, and post-intubation management. Confirmation of tube placement involves clinical assessment and mechanical methods like end-tidal CO2 monitoring and ultrasound. Complications can be minimized by adhering to the standardized RSI protocol.
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1. A 54-year-old Thai man presented with a closed fracture of the left midshaft tibia after a motorcycle accident where he collided with a pickup truck 2 hours prior.
2. Physical examination revealed a well-oriented man with a 3 cm abrasion on his left cheek, but otherwise normal vital signs. Neurological examination was normal except for tenderness and deformity in the left leg.
3. X-rays of the left leg and ankle showed a complete oblique fracture of the left midshaft tibia with soft tissue swelling but no displacement of fragments.
General anesthesia & obstetrics part III
→ Discuss indications of general anesthesia for operative delivery
→ Explain aspiration risk for general anesthesia in pregnancy and prevention strategy
Outline anaesthesia plan of care for induction, maintenance and emergency
Describe effect of volatile anaesthetics on uterine blood flow and tone
Discuss intraoperative strategies to prevent postoperative nausea and vomiting
Discuss other complications of general anaesthesia and clinical management
Rapid intubation
Rapid intubation, also known as rapid sequence intubation (RSI), is an emergency airway management technique used to quickly place an endotracheal tube. It involves preoxygenating the patient, administering induction medications to cause unconsciousness followed immediately by paralysis medications. This allows intubation to be performed without having to manually ventilate the patient first. Proper patient positioning, preparation of equipment, and verification of tube placement are important steps in the technique. Potential complications include esophageal intubation, hypotension, and dental trauma. RSI is the preferred method in emergency situations where immediate airway control is needed.
病房插管小筆記 (Note about Rapid sequence intubation)
The document discusses various aspects of intubation including:
1) Factors to consider when determining if and when to intubate a patient such as inability to maintain airway, respiratory insufficiency, and expected clinical course.
2) The "7 Ps of Rapid Sequence Intubation" process including preparation, preoxygenation, pretreatment, paralysis/induction, positioning, passing the tube, and post-intubation care.
3) Details of drugs commonly used for intubation like etomidate, propofol, midazolam, ketamine, succinylcholine, and rocuronium.
Rapid sequence intubation
Rapid sequence intubation involves several key steps:
1. Preoxygenation of the patient with 100% oxygen for 3 minutes to establish an oxygen reserve before intubation.
2. Administration of sedatives and neuromuscular blocking agents (NMBAs) to gain control of the airway without risk of aspiration.
3. Placement of the endotracheal tube once paralysis is achieved, confirmed by lack of muscle tone and ability to ventilate if oxygen saturation drops below 90%.
4. Postintubation management including chest x-ray, use of long-acting NMBAs, and sedation to facilitate mechanical ventilation.
Discharge criteria of patient What oral surgeon should know
Discharge criteria of patient What oral surgeon should knowDR ISHRAT UL EBAD INSTITUTE OF ORAL HEALTH SCIENCES DIKIOHS
1) Determining when a patient can safely be discharged after sedation or anesthesia is challenging and should involve objective criteria like standardized scales.
2) Common scales used include PADSS, Modified Aldrete Score, and Ped-PADSS which evaluate factors like consciousness, ventilation, oxygenation, circulation, and pain control.
3) Discharge criteria also considers bleeding control, nausea/vomiting prevention, review of postoperative instructions, and follow up care for special populations like diabetics and those with sleep apnea.Rapid Sequence Intubation (RSI)
RSI is a method of intubating patients who have a gag reflex who would otherwise be difficult to intubate. Intubation is accomplished by sedating and paralyzing the patient, allowing for easier intubation.
Rapid sequence intubation in ED
Rapid sequence intubation (RSI) involves the simultaneous administration of an induction agent and neuromuscular blocking drug to facilitate endotracheal intubation. It allows for increased success rates, decreased intubation times, and reduced risks of aspiration, hypoxia, and trauma. The key steps of RSI are preparation, preoxygenation, pretreatment, paralysis with induction, positioning, placement with proof of tube position, and post-intubation management. Confirmation of tube placement involves clinical assessment and mechanical methods like end-tidal CO2 monitoring and ultrasound. Complications can be minimized by adhering to the standardized RSI protocol.
Rapid sequence intubation
This document provides information on rapid sequence intubation (RSI) in adults. It defines RSI as the virtually simultaneous administration of a sedative and neuromuscular blocking agent to facilitate endotracheal intubation while minimizing aspiration risk. The principles of RSI are described, including preparation, preoxygenation, pretreatment, paralysis with induction, protection/positioning, tube placement confirmation, and post-intubation management. Contraindications and advantages of RSI are also outlined.
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Rapid Sequence Intubation (RSI)
Rapid sequence intubation (RSI) is an emergency method used to safely and rapidly intubate a patient's airway while minimizing the risks of regurgitation and aspiration. The steps of RSI include preoxygenation, positioning the patient, administering premedication, applying cricoid pressure, rapidly inducing unconsciousness with drugs like propofol or ketamine, paralyzing the patient with succinylcholine or rocuronium, intubating the trachea, and providing post-intubation care and ventilation. RSI aims to protect patients from complications of aspiration that can occur if the airway is not properly protected during emergency intubation.
RSI sheet-2007
The document discusses Rapid Sequence Intubation (RSI) in emergency departments. RSI involves the simultaneous administration of sedatives and muscle relaxants to quickly induce unconsciousness and paralysis for endotracheal intubation. It outlines the indications, considerations, drugs, and steps involved in RSI. It also discusses managing difficult airways, failed intubations, and rescue devices that can be used if initial intubation attempts fail.
Rapid sequence intubation
Dr. Md Imtiaz Hossain Bhuiyan HDU DOCTOR| IQARUS | Medical Treatment Facility / IQARUS - Cox’s Bazar - Bangladesh Mobile +8801324-404020| Mail: Imtiaz.Bhuiyan@iqarus.com
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The document summarizes key points from an emergency medicine seminar on airway management and intubation. It discusses indications for intubation, preparing for difficult airways and mask ventilation, techniques for rapid sequence intubation including preoxygenation and induction agents, and considerations when choosing between succinylcholine and rocuronium as paralytic agents. Case examples are provided to demonstrate how to assess indications and choose an approach for different patients requiring emergency intubation.
Rapid sequence intubation
RSI involves the simultaneous administration of an induction agent and neuromuscular blocking drug to facilitate endotracheal intubation. It has several advantages including increased success rate of intubation, decreased time to intubation, and minimized risks of aspiration, hypoxia, and trauma during the procedure. The document outlines the steps of RSI, including pre-oxygenation, drug administration, protection and positioning of the patient, endotracheal tube placement and verification, post-intubation management, and potential complications. Key aspects are careful preparation and having backup equipment available in case of difficulties.
Delayed sequence intubation
Delayed sequence intubation involves sedating the patient with an agent that does not paralyze spontaneous breathing or airway reflexes, allowing for effective pre-oxygenation before administering paralysis and intubating. This improves oxygen saturation compared to standard rapid sequence intubation, which risks desaturation if intubation is not immediately successful. The document discusses using ketamine or other sedative agents for pre-oxygenation, then paralyzing and intubating the patient once adequate oxygenation is achieved through nasal prongs, non-rebreather mask, or CPAP depending on the patient's lung and airway status.
Management of life threatening conditions
The document discusses basic life support procedures for cardiovascular emergencies like heart attacks. It describes opening the airway, checking breathing, performing chest compressions, rescue breathing, and using an automated external defibrillator. It also covers spinal cord injuries, types of seizures, medications used to treat seizures, and appropriate first aid responses.
Class anaesthesia for emergency cs
Anaesthesia for emergency caesarean sections poses significant risks. General anaesthesia should only be used if regional techniques cannot be employed within 30 minutes or are contraindicated due to maternal instability. Spinal or epidural anaesthesia are preferred for their safety advantages when time allows. Proper preparation, vigilant monitoring, and treatment of hypotension are essential to mitigate risks during regional or general anaesthesia for emergency caesarean sections.
Approach to the emergency patient
This document provides an overview of the approach to treating emergency patients. It discusses conducting a primary survey following the ABCDE method to assess the airway, breathing, circulation, disability, and exposure. This is followed by taking a history, secondary survey, ordering relevant tests, providing treatment for life-threatening issues, and reevaluating the patient. Key areas covered include managing the airway, treating pneumothorax, hemorrhage control, head injury assessment, and the importance of spinal immobilization.
Airway management techniques by Dr Than Vutha
This document provides information on airway management techniques. It discusses:
- The importance of airway management and oxygenation in resuscitation.
- Clinical assessments for determining when to intubate a patient.
- Basic and advanced airway devices like oropharyngeal airways, endotracheal tubes, and laryngeal mask airways.
- Techniques for opening the airway like head tilt/chin lift and jaw thrust maneuvers.
- Methods for intubation including rapid sequence intubation and its components.
- Approaches for difficult airways including video laryngoscopy and rescue techniques if intubation fails.
Basic trauma life support
This document provides an overview of basic trauma life support. It defines trauma as any bodily injury caused by external energy sources. The primary survey involves a quick assessment of the patient's airway, breathing, circulation, disability, and exposure to identify life-threatening issues. The secondary survey involves a more focused physical exam and history to identify hidden injuries. Key skills covered include spinal immobilization, bleeding control techniques, wound management principles like RICE, and splinting. The overall goal is to rapidly identify and treat life-threatening injuries before transporting the patient to definitive care.
Rsi 01242017 dl2 kevin update
This document provides guidance on rapid sequence intubation (RSI) for airway management. It outlines indications for RSI including failure to protect or compromise of the airway. Relative contraindications include predictors of a difficult airway and patient conditions like unstable fractures or hypersensitivity. The document describes the preparation, pre-treatment, and technique for RSI, including assessing the airway, pre-oxygenation, induction agents, paralytic agents, intubation procedure, and confirmation of proper tube placement. Complications of intubation are also reviewed.
Morning Rounds
Students encounter three simulated patients in the hospital presenting with the same symptom. On each patient, they take a focused history, perform a physical exam, and review diagnostic tests. Students huddle to obtain a shared mental model, then begin a treatment plan. Post simulation debriefing enhances reflection and metacognition.
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1) Mr. AZ, a 21-year-old man, was brought to the ED after a motorbike accident with open fractures of his left forearm bones and bilateral lung contusions.
2) Secondary surveys found additional injuries including possible skull fracture and closed fractures of his right wrist bone.
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Long Case Template : Abdominal Pain and Vomiting 50 Year Old Male
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The patient is a 50-year-old male presenting with severe abdominal pain radiating to his back. He has a fever of 101.3F and is vomiting. His history includes diabetes mellitus. On examination, his abdomen is distended and tender in the right upper quadrant. Initial management should include oxygen, IV fluids, analgesia and antiemetics to make the patient more comfortable. Bedside investigations including an ECG, ABG and urinalysis should be obtained. Laboratory tests including a CBC, coagulation screen, HbA1c, liver function tests and a renal profile are needed.Rapid sequence intubation
Rapid sequence intubation (RSI) is a technique that is used when rapid control of the airway is needed as a precaution for patients that may have a 'full stomach' or other risks of pulmonary aspiration. A short description about RSI procedure according to IQARUS guideline.
Dr. Ummay Sumaiya
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| IQARUS | Medical Treatment Facility / IQARUS - Cox’s Bazar - Bangladesh |
Mail: Ummay.Sumaiya@iqarus.com
Post operative care
Post-operative care involves monitoring the patient's ABCDEs and vital signs. Oxygen therapy is usually provided until the anaesthetic dissipates. Specific considerations depend on the surgery and may involve drain monitoring, stoma care, or extensive physiotherapy. Pain assessment and management is fundamental, using tools like scales and working with a multi-disciplinary team using medication, positioning, and early mobilization. Mobility should begin within 24 hours to prevent complications while monitoring the patient's condition and risks.
Never to happen event
An 82-year-old male underwent an unanticipated right hemicolectomy for an ascending colon tumor. During insertion of a central venous catheter post-operatively, the guidewire was inadvertently pushed into circulation. Despite attempts to retrieve the wire at the hospital, it was identified in the femoral vein on x-ray and the patient was transferred to another hospital for retrieval. The wire was successfully retrieved without complications. The anesthesiologist reflected on how to prevent such an incident in the future, including more supervised practice and improved protocols for central line insertion.
Orthopedic report
A 53-year-old Thai man presented to the emergency department after a motor vehicle accident where he lost control of his car and crashed into a fence. On examination, he had swelling and tenderness of his left proximal tibia with limited range of motion of the left knee due to pain. X-rays showed a left tibial plateau fracture (Schatzker type VI). He was admitted for pain control, immobilization, and pre-operative evaluation in preparation for open reduction internal fixation surgery.
ortho conference
1. A 24-year-old Thai woman presented with left elbow pain after falling on her outstretched left arm 3 hours prior. Examination showed swelling, deformity, and limited range of motion of the left elbow.
2. X-rays confirmed a posterior dislocation of the left elbow.
3. Elbow dislocations are the second most common major joint dislocation after shoulders. Posterolateral dislocations are most common, typically caused by axial loading and external rotation forces. Treatment involves closed reduction and splinting for simple dislocations or surgery for complex injuries.
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Rapid sequence intubation
This document provides information on rapid sequence intubation (RSI) in adults. It defines RSI as the virtually simultaneous administration of a sedative and neuromuscular blocking agent to facilitate endotracheal intubation while minimizing aspiration risk. The principles of RSI are described, including preparation, preoxygenation, pretreatment, paralysis with induction, protection/positioning, tube placement confirmation, and post-intubation management. Contraindications and advantages of RSI are also outlined.
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This document discusses occult stress urinary incontinence (SUI) associated with pelvic organ prolapse (POP). [1] Between 36-80% of women with POP have occult SUI that is only revealed when the prolapse is reduced. [2] There is no standardized method for diagnosing occult SUI. Methods to reduce the prolapse include pessaries, vaginal packs, and speculums. Cough tests during filling cystometry can identify urine leakage indicative of SUI. [3] Treatment options include postponing or performing concomitant anti-incontinence surgery with POP repair. More studies are needed to determine best practices for diagnosing and treating occult SUI.
Rapid Sequence Intubation (RSI)
Rapid sequence intubation (RSI) is an emergency method used to safely and rapidly intubate a patient's airway while minimizing the risks of regurgitation and aspiration. The steps of RSI include preoxygenation, positioning the patient, administering premedication, applying cricoid pressure, rapidly inducing unconsciousness with drugs like propofol or ketamine, paralyzing the patient with succinylcholine or rocuronium, intubating the trachea, and providing post-intubation care and ventilation. RSI aims to protect patients from complications of aspiration that can occur if the airway is not properly protected during emergency intubation.
RSI sheet-2007
The document discusses Rapid Sequence Intubation (RSI) in emergency departments. RSI involves the simultaneous administration of sedatives and muscle relaxants to quickly induce unconsciousness and paralysis for endotracheal intubation. It outlines the indications, considerations, drugs, and steps involved in RSI. It also discusses managing difficult airways, failed intubations, and rescue devices that can be used if initial intubation attempts fail.
Rapid sequence intubation
Dr. Md Imtiaz Hossain Bhuiyan HDU DOCTOR| IQARUS | Medical Treatment Facility / IQARUS - Cox’s Bazar - Bangladesh Mobile +8801324-404020| Mail: Imtiaz.Bhuiyan@iqarus.com
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The document summarizes key points from an emergency medicine seminar on airway management and intubation. It discusses indications for intubation, preparing for difficult airways and mask ventilation, techniques for rapid sequence intubation including preoxygenation and induction agents, and considerations when choosing between succinylcholine and rocuronium as paralytic agents. Case examples are provided to demonstrate how to assess indications and choose an approach for different patients requiring emergency intubation.
Rapid sequence intubation
RSI involves the simultaneous administration of an induction agent and neuromuscular blocking drug to facilitate endotracheal intubation. It has several advantages including increased success rate of intubation, decreased time to intubation, and minimized risks of aspiration, hypoxia, and trauma during the procedure. The document outlines the steps of RSI, including pre-oxygenation, drug administration, protection and positioning of the patient, endotracheal tube placement and verification, post-intubation management, and potential complications. Key aspects are careful preparation and having backup equipment available in case of difficulties.
Delayed sequence intubation
Delayed sequence intubation involves sedating the patient with an agent that does not paralyze spontaneous breathing or airway reflexes, allowing for effective pre-oxygenation before administering paralysis and intubating. This improves oxygen saturation compared to standard rapid sequence intubation, which risks desaturation if intubation is not immediately successful. The document discusses using ketamine or other sedative agents for pre-oxygenation, then paralyzing and intubating the patient once adequate oxygenation is achieved through nasal prongs, non-rebreather mask, or CPAP depending on the patient's lung and airway status.
Management of life threatening conditions
The document discusses basic life support procedures for cardiovascular emergencies like heart attacks. It describes opening the airway, checking breathing, performing chest compressions, rescue breathing, and using an automated external defibrillator. It also covers spinal cord injuries, types of seizures, medications used to treat seizures, and appropriate first aid responses.
Class anaesthesia for emergency cs
Anaesthesia for emergency caesarean sections poses significant risks. General anaesthesia should only be used if regional techniques cannot be employed within 30 minutes or are contraindicated due to maternal instability. Spinal or epidural anaesthesia are preferred for their safety advantages when time allows. Proper preparation, vigilant monitoring, and treatment of hypotension are essential to mitigate risks during regional or general anaesthesia for emergency caesarean sections.
Approach to the emergency patient
This document provides an overview of the approach to treating emergency patients. It discusses conducting a primary survey following the ABCDE method to assess the airway, breathing, circulation, disability, and exposure. This is followed by taking a history, secondary survey, ordering relevant tests, providing treatment for life-threatening issues, and reevaluating the patient. Key areas covered include managing the airway, treating pneumothorax, hemorrhage control, head injury assessment, and the importance of spinal immobilization.
Airway management techniques by Dr Than Vutha
This document provides information on airway management techniques. It discusses:
- The importance of airway management and oxygenation in resuscitation.
- Clinical assessments for determining when to intubate a patient.
- Basic and advanced airway devices like oropharyngeal airways, endotracheal tubes, and laryngeal mask airways.
- Techniques for opening the airway like head tilt/chin lift and jaw thrust maneuvers.
- Methods for intubation including rapid sequence intubation and its components.
- Approaches for difficult airways including video laryngoscopy and rescue techniques if intubation fails.
Basic trauma life support
This document provides an overview of basic trauma life support. It defines trauma as any bodily injury caused by external energy sources. The primary survey involves a quick assessment of the patient's airway, breathing, circulation, disability, and exposure to identify life-threatening issues. The secondary survey involves a more focused physical exam and history to identify hidden injuries. Key skills covered include spinal immobilization, bleeding control techniques, wound management principles like RICE, and splinting. The overall goal is to rapidly identify and treat life-threatening injuries before transporting the patient to definitive care.
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Morning Rounds
Students encounter three simulated patients in the hospital presenting with the same symptom. On each patient, they take a focused history, perform a physical exam, and review diagnostic tests. Students huddle to obtain a shared mental model, then begin a treatment plan. Post simulation debriefing enhances reflection and metacognition.
ED Case Discussion - Trauma (reviewed)
1) Mr. AZ, a 21-year-old man, was brought to the ED after a motorbike accident with open fractures of his left forearm bones and bilateral lung contusions.
2) Secondary surveys found additional injuries including possible skull fracture and closed fractures of his right wrist bone.
3) The patient was resuscitated for hypovolemic shock and underwent wound care, imaging, and splinting while awaiting stabilization for orthopedic surgery.
Long Case Template : Abdominal Pain and Vomiting 50 Year Old Male
Long Case Template : Abdominal Pain and Vomiting 50 Year Old MaleMedvizz institute of medical education
The patient is a 50-year-old male presenting with severe abdominal pain radiating to his back. He has a fever of 101.3F and is vomiting. His history includes diabetes mellitus. On examination, his abdomen is distended and tender in the right upper quadrant. Initial management should include oxygen, IV fluids, analgesia and antiemetics to make the patient more comfortable. Bedside investigations including an ECG, ABG and urinalysis should be obtained. Laboratory tests including a CBC, coagulation screen, HbA1c, liver function tests and a renal profile are needed.Rapid sequence intubation
Rapid sequence intubation (RSI) is a technique that is used when rapid control of the airway is needed as a precaution for patients that may have a 'full stomach' or other risks of pulmonary aspiration. A short description about RSI procedure according to IQARUS guideline.
Dr. Ummay Sumaiya
ICU DOCTOR
| IQARUS | Medical Treatment Facility / IQARUS - Cox’s Bazar - Bangladesh |
Mail: Ummay.Sumaiya@iqarus.com
Post operative care
Post-operative care involves monitoring the patient's ABCDEs and vital signs. Oxygen therapy is usually provided until the anaesthetic dissipates. Specific considerations depend on the surgery and may involve drain monitoring, stoma care, or extensive physiotherapy. Pain assessment and management is fundamental, using tools like scales and working with a multi-disciplinary team using medication, positioning, and early mobilization. Mobility should begin within 24 hours to prevent complications while monitoring the patient's condition and risks.
Never to happen event
An 82-year-old male underwent an unanticipated right hemicolectomy for an ascending colon tumor. During insertion of a central venous catheter post-operatively, the guidewire was inadvertently pushed into circulation. Despite attempts to retrieve the wire at the hospital, it was identified in the femoral vein on x-ray and the patient was transferred to another hospital for retrieval. The wire was successfully retrieved without complications. The anesthesiologist reflected on how to prevent such an incident in the future, including more supervised practice and improved protocols for central line insertion.
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Long Case Template : Abdominal Pain and Vomiting 50 Year Old Male
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Orthopedic report
A 53-year-old Thai man presented to the emergency department after a motor vehicle accident where he lost control of his car and crashed into a fence. On examination, he had swelling and tenderness of his left proximal tibia with limited range of motion of the left knee due to pain. X-rays showed a left tibial plateau fracture (Schatzker type VI). He was admitted for pain control, immobilization, and pre-operative evaluation in preparation for open reduction internal fixation surgery.
ortho conference
1. A 24-year-old Thai woman presented with left elbow pain after falling on her outstretched left arm 3 hours prior. Examination showed swelling, deformity, and limited range of motion of the left elbow.
2. X-rays confirmed a posterior dislocation of the left elbow.
3. Elbow dislocations are the second most common major joint dislocation after shoulders. Posterolateral dislocations are most common, typically caused by axial loading and external rotation forces. Treatment involves closed reduction and splinting for simple dislocations or surgery for complex injuries.
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This document summarizes a case conference about a 56-year-old Thai female patient who presented to the emergency room with right arm pain after a water tank fell on her arm. On examination, she had deformity and swelling of the right arm with tenderness over the mid humerus and limited range of motion. X-rays showed a fracture of the distal one-third of the right humerus shaft. She was given pain medication, her arm was reduced and placed in a U-slab cast. She was diagnosed with a distal right humerus shaft fracture and advised to follow up in one week.
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This case conference discusses a 45-year-old Thai male who was in a motor vehicle accident where he sustained a left humerus fracture. On physical examination, his left arm was tender and swollen with limited range of motion due to pain. X-rays confirmed a closed midshaft left humerus fracture. Treatment options for humerus fractures include non-operative management with a hanging arm cast or functional brace, or operative management with plate fixation or intramedullary nails depending on the fracture pattern and patient factors. Complications can include radial nerve palsy.
Extern orthopedics-conference
1) The patient is a 60-year-old Thai male who presented to the hospital with left hip pain after being hit by a motorcycle 14 hours prior.
2) Physical examination revealed localized tenderness and limited range of motion of the left hip. X-rays showed a closed fracture of the left intertrochanteric region.
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CASE CAPSULE CORNEAL ULCER.pptx
A 30-year-old male farmer presented with a painless swelling on his right lower eyelid that had grown over the past 3 months. He had previously sought treatment at a private hospital for the mass, with details unknown. During that prior treatment, he experienced trauma to his right eye from a glass particle, which caused bleeding and ulceration of the mass. Examination revealed a 1.5cm x 1.5cm oval, cystic mass arising from the middle third of the lower eyelid margin, causing mechanical ectropion. The mass was pinkish in color with dilated blood vessels and a healing ulcer. A provisional diagnosis was made but not stated in the document.
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Case conference
This case conference discusses a 31-year-old male patient who was in a motorcycle accident 3 hours prior. He has abrasions on his face and left leg, and swelling and tenderness in his left forearm. An x-ray reveals a closed fracture of both bones in the left forearm. The patient is given morphine and his arm is placed in a long arm splint before being admitted for observation to monitor for compartment syndrome. The discussion then reviews anatomy of the forearm bones, mechanisms of injury, management, treatment including closed or open reduction depending on the patient, and complications of forearm fractures like malunion or compartment syndrome.
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This document summarizes the presentation of an extern on the case of a 91-year-old Thai woman who fell from a roof and suffered an odontoid fracture. After initial assessment and imaging at a local hospital showed possible C1 fracture, she was transferred to a larger hospital. Further imaging including CT revealed an Anderson Type II odontoid fracture. Type II fractures have a high nonunion rate due to interrupted blood supply and were discussed in detail, including classification, presentation, imaging, treatment options of either immobilization or surgery, and complications like nonunion.
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Case discussion ortho jeen
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Ortho pom (1)
1) The patient is a 59-year-old Thai woman who fell and injured her left wrist. She was brought to the emergency department with a deformity and swelling of her left wrist.
2) X-rays showed a fracture of the distal radius, known as a Colles' fracture.
3) The fracture was treated with closed reduction, hematoma block, and application of a short arm splint.
The key points were that the patient fell and injured her left wrist, x-rays showed a Colles' fracture of the distal radius, and the fracture was treated non-operatively with closed reduction and splinting.
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The document summarizes an orthopedic case of a child who fell from a table and injured his left arm. On physical examination, the child's left elbow was swollen and deformed with limited range of motion due to pain. X-rays revealed a complete transverse fracture at the supracondylar region of the left humerus with total posterior-medial displacement, classified as a Gartland Type III injury. The child underwent closed reduction and percutaneous pinning of the fractured elbow. Post-operatively, the child will need elevation, pain control, range of motion exercises, and pin removal after 3-4 weeks once the fracture has healed. Complications of this type of injury can include nerve damage,
.Ortho.
An 81-year-old Thai woman presented to the hospital with left hip pain after falling three days prior. Imaging revealed a Garden type 3 fracture of the left femoral neck. She was diagnosed with a displaced left femoral neck fracture. Her treatment plan included pain control, skin traction of the left leg, and a left bipolar hemiarthroplasty surgery. Femoral neck fractures typically result from low-energy falls in older patients and require prompt surgical management to reduce complications.
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Acinjury chitphisut-chennisata
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Ortho..
- The patient is a 38-year-old Thai man who was in a motorcycle accident after drinking alcohol. He complains of left knee pain for 3 hours.
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Extern conference may
- An 11-year-old Thai girl presented with left elbow pain and swelling after being knocked over by a dog at home. She had limited range of motion of her left elbow due to pain.
- X-rays showed a closed fracture of the left supracondylar humerus, classified as a Gartland type II.
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A 19-year-old Thai male presented to the emergency room after his motorcycle was hit by a car. He reported left knee pain for 30 minutes. On examination, he had a 4x6cm laceration wound on his left knee with exposed bone and active bleeding. Imaging showed an open left patellar fracture. He was diagnosed with an open left patellar fracture and treated empirically with antibiotics. He underwent debridement and tension band wiring in the operating room.
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Extern.con.anklefx.chaipat
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Ortho con
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Syllabus
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Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
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Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
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Fon ortho final copy
- 2. PATIENT PROFILE ▸ผู้ป่วยชายอายุ 23 ปี สัญชาติไทย ศาสนาพุทธ ▸ภูมิลาเนา อ.สูงเนิน จังหวัด นครราชสีมา ▸สิทธิการรักษา บัตรทอง
- 4. PRESENT ILLNESS ▸1hr PTA ป่วยขับรถมอเตอร์ไซต์ชนท้ายรถกระบะ ไม่สลบ จาเหตุการณ์ได้ ไม่ได้ดื่ม แอลกอฮอล์ เจ็บบริเวณแขนซ้าย มีแผลเลือดไหล ไม่ชา ▸EMSนาส่งโรงพยาบาลมหาราชนครราชสีมา
- 6. PHYSICAL EXAMINATION Primary survey ▸A :can speak, c -spine not tender ▸B:CCT neg ,normal breath sound both lungs, trachea in midline, RR 20 ▸C: BP 140/70 mmHg, HR 60 bpm ▸D:E4V5M6 pupil 3 mmRTLBE ▸E:Abrasion wound 2x2 cm at left knee
- 7. TEXT Secondary survey ‣ A:no food or drug allergy ▸M:no current medication ▸P:no underlying disease ▸L:last meal 5 pm ▸E:His motorcycle is crashed into car ,he feels pain at his left knee
- 8. HEAD TO TOE EVALUATION ▸Heart normal S1S2 , no murmur ▸Lung clear breath sound both lungs ▸Abdomen soft ,not tender ▸Neurological E4V5M6 pupil 3 mmLTLBE
- 9. ▸Extremities laceration wound 2x2 cm at left arm with left arm deformity, capillary refill<2 sec,limit ROM ` ▸Abrasion wound 2x2 cm at left knee Type to enter a caption.
- 10. INVESTIGAT N
- 14. DIAGNOSIS ▸Open fracture at left shaft of humerus
- 15. MANAGEMENT ▸Set OR for debridement with plate and screw
- 18. INCIDENT ‣ 3-5% of all fractures ‣ bimodal age distribution ‣ young patients with high-energy trauma ‣ elderly, osteopenic patients with low-energy injuries
- 19. PRESENTATION ‣ pain ‣ extremity weakness ‣ shortening and in varus preoperative or pre-reduction neurovascular exam is critical examine and document status of radial nerve pre and post- reduction
- 20. IMAGING ▸Recommend view AP and lateral view of humerus ▸Additional view ▸Tranthoracic lateral for sagittal plan deformity ▸Traction view for fracture with significant shortening, proximal or distal extension
- 21. COMPLICATION ▸Humeral shaft fracture nonunion ▸Humeral shaft fracture malunion :varus angulation is common ▸Radial nerve palsy
- 22. RADIAL NERVE PALSY ‣ Increase incident distal one-third fractures ‣ Neuropraxia most common injury in closed fractures and neurosis in open fractures ‣ 85-90% of improve with observation over 3 months ‣ Spontaneous recovery found at an average of 7 weeks, with full recovery at an average of 6 months
- 23. HOLSTEIN LEWIS FRACTURE ▸A spiral fracture of the distal one-third of the humeral shaft commonly associated with neuropraxia of the radial nerve
- 24. TREATMENT Observation ‣ Indication closed humerus fracture ‣ Obtain EMG at 3-4 months ‣ Wrist extension in radial deviation is expected to regain first ‣ Brachioradialis first to recovery ,extensor indicis is the last
- 25. Surgical exploration Indication ‣ Open fracture with radial nerve palsy ‣ Closed fracture that fails to improve over 3-6 months ‣ Denervation seen at 3-4 months on EMG
- 26. TREATMENT Non operative ‣ U slab
- 27. OPERATIVE :ORIF ▸Indication - >20 degree anterior angulation -> 30 degree varus/valgus angulation ->3 cm shortening -open fracture -vascular injury require repair -brachial plexus injury -floating elbow -compartment syndrome