What to Expect After You're Done Expecting
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Nerve Block of Lateral Femoral Cutaneous Nerve of the Thigh
18VTLLAA 1 Nerve block of lateral femoral cutaneous nerve of the thigh. Dr. Robert M Raw (MD) . MBChB, MFGP, MPraxMed, DA, FCA. Professor of Anesthesia retired Editor of Regional-Anesthesia.Com INDEX. 1. Introduction 2. Anatomy 3. Choice of local anesthetic 4. General indications 5. Complications and side effects 6. Conclusion ------------------------------------------------------------------------------------ 1. INTRODUCTION The lateral femoral cutaneous nerve of the thigh (LFCN) is the single human nerve most subject to anatomic variations. Figure #1shows the dermatome of LFCN. The nerve is small and mostly invisible under ultrasound scanning. For nerve block success, drug must be injected into four fascial compartments, each of which a variant nerve type may pass through in different individuals. 2. ANATOMY The lateral femoral cutaneous nerve is a sensory nerve supplying the skin on the lateral aspect of the thigh. That sensory area nearly reaches the thigh posterior midline and the thigh anterior midline. Its superior limit passes over the greater trochanter and its inferior limit nearly reaches the height of the patella. The typical LCNT, in 60% of patients, is a branch of the lumbar plexus deriving from the dorsal divisions of nerve roots L2 and L3. The LFCN forms within the psoas muscle, and exits the pelvis medial to the anterior superior iliac spine (ASIS) and under the inguinal ligament. It then passes over the sartorius muscle, under fascia lata, before branching into its final Figure 1. Classic dermatomal distribution of the divisions. In forty percent of patients the LFCN lateral femoral cutaneous nerve (LFCN), derived has completely different anatomy, but from Sobotta. fortunately the nerve always passes in proximity to the proximal sartorius muscle. -
Prevalence of Diastasis of the Rectus Abdominis Muscles Immediately Postpartum: Comparison Between Primiparae and Multiparae
ISSN 1413-3555 Rev Bras Fisioter, São Carlos, v. 13, n. 4, p. 275-80, jul./ago. 2009 ARTIGO ORIGIN A L ©Revista Brasileira de Fisioterapia Prevalência de diástase dos músculos retoabdominais no puerpério imediato: comparação entre primíparas e multíparas Prevalence of diastasis of the rectus abdominis muscles immediately postpartum: comparison between primiparae and multiparae Rett MT1,2, Braga MD2, Bernardes NO1,2, Andrade SC2 Resumo Objetivos: Verificar a prevalência da diástase dos músculos retoabdominais (DMRA) em primíparas e multíparas no pós-parto vaginal imediato, comparar a DMRA supraumbilical e infraumbilical e correlacioná-las com a idade materna, o índice de massa corporal (IMC), a idade gestacional (IG) e o tempo de trabalho de parto (TTP). Métodos: Foi realizado um estudo transversal, sendo registradas informações pessoais, antecedentes obstétricos e a DMRA supra e infraumbilical. Os pontos de medida foram 4,5 cm acima e abaixo da cicatriz umbilical, sendo graduada pelo número de dedos entre as bordas mediais dessa musculatura. Para cada dedo, foi estimado 1,5 cm. A DMRA foi considerada presente e relevante quando houvesse um afastamento >2 cm na região supra e/ou infraumbilical. Resultados: Foram analisadas 467 fichas de dados, sendo a prevalência da DMRA supraumbilical >2 cm de 68% e infraumbilical de 32%. A prevalência supraumbilical entre as primíparas e multíparas foi idêntica (68%) e infraumbilical maior nas multíparas (19,8% e 29,2%). As médias da DMRA foram 2,8 (±1,2) cm supraumbilical e 1,5 (±1,1) cm infraumbilical, apresentando diferença significativa (p=0,0001) e fraca correlação (r=0,461). A média da DMRA infraumbilical foi significativamente maior nas multíparas (p<0,018). -
Physical Therapy Assessment
Physical Therapy Assessment Patient Name __________________________________________ Sex M F Date _________________ First MI Last MM / DD / YYYY DOB______________ What are your goals? _____________________________________________________ MM / DD / YYYY Medical History Have you been admitted to the Emergency Room in the past year? Yes No When? __________________________________________________________________________________ Have you been admitted to the Hospital in the past year?Yes No When? __________________________________________________________________________________ History or broken bones, fractures?Yes No When and Where?________________________________________________________________________ Do you experience Headaches?Yes No How long do they last? ____________________ How often do you have them? ____________________ What makes them worse? __________________________ What helps? __________________________ Have you had any surgical procedure(s) performed? Yes No When? __________________________________________________________________________________ Describe the surgery: _____________________________________________________________________ Have you experienced head trauma including concussion, traumatic brain injury, whiplash? Yes No When? __________________________________________________________________________________ Describe what happened: _________________________________________________________________ Have you ever been in a car accident? Yes No When? __________________________________________________________________________________ -
Preparatory: 1 Venous Access and Medication Administration: 4
Preparatory: 1 Venous Access and Medication Administration: 4 W4444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444 UNIT TERMINAL OBJECTIVE 1-4 At the completion of this unit, the EMT-Critical Care Technician student will be able to safely and precisely access the venous circulation and administer medications. COGNITIVE OBJECTIVES At the completion of this unit, the EMT-Critical Care Technician student will be able to: 1-4.1 Review the specific anatomy and physiology pertinent to medication administration. (C-1) 1-4.2 Review mathematical principles. (C-1) 1-4.3 Review mathematical equivalents. (C-1) 1-4.4 Differentiate temperature readings between the Centigrade and Fahrenheit scales. (C-3) 1-4.5 Discuss formulas as a basis for performing drug calculations. (C-1) 1-4.6 Calculate oral and parenteral drug dosages for all emergency medications administered to adults, infants and children. (C-2) 1-4.7 Calculate intravenous infusion rates for adults, infants, and children. (C-2) 1-4.8 Discuss legal aspects affecting medication administration. (C-1) 1-4.9 Discuss the "six rights" of drug administration and correlate these with the principles of medication administration. (C-1) 1-4.10 Discuss medical asepsis and the differences between clean and sterile techniques. (C-1) 1-4.11 Describe use of antiseptics and disinfectants. (C-1) 1-4.12 Describe the use of universal precautions and body substance isolation (BSI) procedures when administering a medication. (C-1) 1-4.13 Describe the indications, equipment needed, techniques utilized, precautions, and general principles of peripheral venous cannulation (Including saline locks). (C-1) 1-4.14 Describe the indications, equipment needed, techniques utilized, precautions, and general principles of intraosseous needle placement and infusion. -
Abdominoplasty Sur716.002 ______Coverage
ABDOMINOPLASTY SUR716.002 ______________________________________________________________________ COVERAGE: Abdominoplasty and/or removal of the overhanging lower abdominal panniculus are considered cosmetic procedures. Abdominoplasty is sometimes described as a wide internal oblique transverse abdominous plication (a wide rectus plication). No coverage is available for these procedures or for repair of a diastasis recti in the absence of a true midline hernia (ventral or umbilical). On rare occasions, abdominoplasty may be considered for coverage with determination of medical necessity for indications such as the following: · in an older individual who has such a significantly large panniculus as to interfere with the ability to walk normally or in a patient with documented pressure sores, rash, or intertriginous maceration that has not responded to all manners of conservative treatment, or · in an individual who has had multiple operations with spreading of the scar associated with diastasis recti and a true incisional hernia defect. NOTE: The presence of back pain alone without one of the preceding indications will not constitute medical necessity for abdominoplasty. ______________________________________________________________________ DESCRIPTION: Abdominoplasty is a plastic repair of the anterolateral abdominal wall, which is largely muscular and aponeurotic (a white flattened or ribbon-like tendonous expansion serving mainly to connect a muscle with the parts that it moves), with overlying subcutaneous tissue and skin. Abdominal wall pathophysiology concerns weakness or laxity of the abdominal wall musculature. This prevents maximum force generation with contraction and weakens the support of the lumber dorsal fascia with resultant back pain. An excess of ten pounds of adipose tissue in the abdominal wall adds 100 pounds of strain on the discs of the lower back by exaggeration of the normal S curve of the spine. -
Handbook ESRA
TECHNIQUES HEAD & NECK 4 Intracranial surgery p. 3 Eye blocks p. 5 Face anatomy p. 16 Face particularity p. 23 Ophtalmic nerve blocks p. 27 Maxillary nerve blocks p. 33 Mandibular nerve blocks p. 46 THORAX & ABDOMEN 50 Epidural anaesthesia in Cardio-thoracic surgery p. 50 Ilioinguinal-Iliohypogastric block p. 55 Peri-umbilical & Rectus sheath block p. 57 Pudendal block p. 58 UPPER LIMB 61 Choice of a technique p. 61 Brachial plexus anatomy p. 65 Interscalen block p. 68 Supraclavicular blocks p. 73 Infraclavicular blocks p. 80 Axillary block p. 83 LOWER LIMB 90 Lumbar plexus block p. 90 Iliofascial block p. 100 Obturator block p. 102 Sciatic blocks o Sciatic blocks - parasacral nerve approach p. 109 o Sciatic blocks - posterior popliteal approach p. 115 Ankle blocks p. 119 AXIAL BLOCKS 123 Lumbar epidural p. 123 OBSTETRICS AXIAL BLOCKS 126 Epidural p. 126 PERIPHERAL BLOCKS Pudendal block p. 58 2 Aknowledgement The provenience of the materials included in this handbook is from the Learning Zone on the official site of “European Society of Regional Anesthesia and Pain Therapy”. http://www.esra-learning.com/ 2007 3 HEAD & TABLE OF CONTENTS NECK • Intracranial surgery • Eye blocks • Face anatomy • Face particularity • Ophtalmic nerve blocks • Maxillary nerve blocks • Mandibular nerve blocks • Cervical plexus blocks HEAD & INTRACRANIAL SURGERY NECK Paul J. Zetlaoui, M.D. Kremlin-Bicetre - France In intra-cranial neurosurgery, scalp infiltration aims to prevent systematic and cerebral hemodynamic variations, contemporary of skin incision. The potential morbidity of these hypertension-tachycardia episodes, even in patients profoundly anaesthetized, is secondary in the increase of the cerebral blood flow and in its deleterious consequences on intra-cranial pressure in these compromised patients. -
F110 Genetics Physical Exam, Part II
Bench to Bassinet Pediatric Cardiac Genomics Consortium: CHD GENES Form 110: Genetics Physical Exam - Part II Version: C - 06/22/2011 SECTION A: ADMINISTRATIVE INFORMATION F1 Skin A1. Study Identification Number: F2 Chest F3 Inter A2. Study Visit: Proband Subject Baseline Visit F4 Nippl A3. Date Form Completed: MM/DD/YYYY F5 Chest F6 Abdo SECTION F: SKIN, CHEST, ABDOMEN, AND BACK F7 Back Normal Abnormal Unknown Source G1 Genit Pending H1 Hand F1. Skin: I1 Feet a. Ashleaf spots J1 Neuro b. Café-au-lait spots c. Cutis marmata d. Hemangioma e. Hyperkeratosis f. Hyperpigmented lesions g. Hypopigmented lesions h. Lipoma i. Port wine spots j. Skin tag k. Telangiectasia l. Other i. If Other, specify: F2. Chest circumference: cm F3. Inter-Nipple Distance (IND): cm Normal Wide Closely Unknown Source Spaced Spaced Pending Nipples Nipples F4. Nipples: Normal Abnormal Unknown Source Pending F5. Chest: a. Barrel b. Absent/ hypoplastic clavicles c. Narrow d. Supernumerary Nipples e. Absent pectoralis muscle f. Pectus Carinatum g. Pectus Excavatum h. Absent Ribs i. Supernumerary Ribs j. Short k. Other i. If Other, specify: Normal Abnormal Unknown Source Pending F6. Abdomen: a. Abdominal Mass b. Diastasis recti c. Gastroschisis d. Inguinal Hernia e. Umbilical Hernia f. Left-sided Liver g. Midline Liver h. Omphalocele i. Splenomegaly j. Other i. If Other, specify: Normal Abnormal Unknown Source Pending F7. Back: a. Kyphosis b. Meningomyelocele c. Sacral Dimple d. Scoliosis e. Winged Scapula Unilateral Bilateral No f. Other i. If Other, specify: SECTION G: GENITOURINARY (HISTORY OF OR PRESENT) Normal Abnormal Unknown Source Pending G1. -
The Development of an Intramuscular Injection Simulation for Nursing Students
Open Access Technical Report DOI: 10.7759/cureus.12366 The Development of an Intramuscular Injection Simulation for Nursing Students Julia Micallef 1 , Artur Arutiunian 1 , Adam Dubrowski 1 1. Health Sciences, Ontario Tech University, Oshawa, CAN Corresponding author: Adam Dubrowski, [email protected] Abstract Intramuscular (IM) injections are preferred over subcutaneous injections for administering medicine such as epinephrine and vaccines as the muscle tissue contains an increased vascular supply that provides ideal absorption of the drug being administered. However, administering an IM injection requires clinical judgment when choosing the injection site, understanding the relevant anatomy and physiology as well as the principles and techniques for administering an IM injection. Therefore, it is essential to learn and perform IM injections using injection simulators to practice the skill before administering to a real patient. Current IM injection simulators either favor realism at the expense of standardization or are expensive but do not provide a realistic experience. Therefore, it is imperative to develop an inexpensive but realistic intramuscular injection simulator that can be used to train nursing students so that they can be prepared for when they enter the clinical setting. This technical report aims to provide an overview of the development of an inexpensive and realistic deltoid simulator geared to teach nursing students the skill of IM injections. After development, the IM simulators were tested and validated by practicing nurses. An 18-item survey was administered to the nurses, and results indicated positive feedback about the realism of the simulator, in comparison to previous models used, such as the Wallcur® PRACTI-Injecta Pads (Wallcur LLC, San Diego, CA). -
Diastasis Recti
In This Chapter Benefits and Risks of Exercise During Pregnancy Maternal Fitness Gestational Diabetes Preeclampsia Maternal Obesity Maternal Exercise and the Fetal Response Contraindications and Risk Factors Physiological Changes During Pregnancy Musculoskeletal System Cardiovascular System Respiratory System Thermoregulatory System Programming Guidelines and Considerations for Prenatal Exercise Biomechanical Considerations for the Pregnant Mother Low-back and Posterior Pelvic Pain Pubic Pain Carpal Tunnel Syndrome Diastasis Recti About The Author Stress Urinary Incontinence Sabrena Merrill, M.S., has been actively involved in the fitness Nutritional Considerations industry since 1987. An ACE-certified Group Fitness Instructor Psychological Considerations and Personal Trainer, Merrill teaches group exercise, owns and Benefits and Risks of Exercise Following Pregnancy operates her own personal training business, has managed Physiological Changes Following fitness departments in commercial facilities, and lectured to Pregnancy university students and established fitness professionals. She Programming Guidelines and Considerations for Postnatal has a bachelor’s degree in exercise science as well as a master’s Exercise degree in physical education from the University of Kansas, and Biomechanical Considerations for the Lactating Mother has numerous certifications in exercise instruction. Merrill acts Case Study as a spokesperson for the American Council on Exercise (ACE) Summary and is involved in curriculum development for ACE continuing education programs. Additionally, Merrill presents lectures and workshops to fitness professionals nationwide. CHAPTER 23 Pre- and Postnatal Exercise Sabrena Merrill n increasing amount of research on exercise in pregnancy has led to a waning debate over the maternal and fetal risks of regular physical activity during pregnancy. There is a growing trend of women entering pregnancy with regu- Alar aerobic and strength-conditioning activities as a part of their daily routines. -
F-06 Thematic Poster
Official Journal of the American College of Sports Medicine Vol. 52 No. 5 Supplement S641 F-06 Thematic Poster - Cardiovascular Health in 2942 Board #2 May 29 1:00 PM - 3:00 PM Firefighters Firefighters With More Service Have Smaller Blood Pressure Surge When The Pager Sounds Friday, May 29, 2020, 1:00 PM - 3:00 PM Megan A. Carty1, Rachel L. Dickinson2, Emily H. Reeve3, Emily Room: CC-2009 N. Blaszkow1, Julia Gilpin1, Brian Varani1, Meghan Lashley1, Paige E. DeAlba1, Deborah L. Feairheller4. 1Ursinus College, Collegeville, PA. 2Pennsylvania Dermatology Group, Huntington 2940 Chair: Denise L. Smith, FACSM. Skidmore College, Saratoga Valley, PA. 3University of Oregon, Eugene, OR. 4University of Springs, NY. New Hampshire, Durham, NH. (Sponsor: Deborah Feairheller, (No relevant relationships reported) FACSM) (No relevant relationships reported) 2941 Board #1 May 29 1:00 PM - 3:00 PM Cardiac incidents cause over 50% of LODD in firefighters (FF) and may be related to Acute Effects Of Firefighting On Vascular Health And their BP responses. Also, years of service may affect FF stress and depression levels Blood Pressure and impair overall health. Using ambulatory BP (ABP) monitoring to quantify the BP surge with alarm is a novel way to assess risk, and preliminary data showed that newer 1 2 3 Robert M. Restaino , Gavin P. Horn , Steve Kerber , Kenneth FF have higher BP surge. PURPOSE: To compare changes in health between FF with 4 5 6 1 W. Fent , Bo Fernhall , Denise L. Smith, FACSM . Skidmore <10yr service (FF-10) and FF with >10yr service (FF+10) after a 6-wk Mediterranean 2 College, Saratoga Springs, NY. -
The Digestive System
69 chapter four THE DIGESTIVE SYSTEM THE DIGESTIVE SYSTEM The digestive system is structurally divided into two main parts: a long, winding tube that carries food through its length, and a series of supportive organs outside of the tube. The long tube is called the gastrointestinal (GI) tract. The GI tract extends from the mouth to the anus, and consists of the mouth, or oral cavity, the pharynx, the esophagus, the stomach, the small intestine, and the large intes- tine. It is here that the functions of mechanical digestion, chemical digestion, absorption of nutrients and water, and release of solid waste material take place. The supportive organs that lie outside the GI tract are known as accessory organs, and include the teeth, salivary glands, liver, gallbladder, and pancreas. Because most organs of the digestive system lie within body cavities, you will perform a dissection procedure that exposes the cavities before you begin identifying individual organs. You will also observe the cavities and their associated membranes before proceeding with your study of the digestive system. EXPOSING THE BODY CAVITIES should feel like the wall of a stretched balloon. With your skinned cat on its dorsal side, examine the cutting lines shown in Figure 4.1 and plan 2. Extend the cut laterally in both direc- out your dissection. Note that the numbers tions, roughly 4 inches, still working with indicate the sequence of the cutting procedure. your scissors. Cut in a curved pattern as Palpate the long, bony sternum and the softer, shown in Figure 4.1, which follows the cartilaginous xiphoid process to find the ventral contour of the diaphragm. -
Pressure Ulcer Staging Guide
Pressure Ulcer Staging Guide Pressure Ulcer Staging Guide STAGE I STAGE IV Intact skin with non-blanchable Full thickness tissue loss with exposed redness of a localized area usually Reddened area bone, tendon, or muscle. Slough or eschar may be present on some parts Epidermis over a bony prominence. Darkly Epidermis pigmented skin may not have of the wound bed. Often includes undermining and tunneling. The depth visible blanching; its color may Dermis of a stage IV pressure ulcer varies by Dermis differ from the surrounding area. anatomical location. The bridge of the This area may be painful, firm, soft, nose, ear, occiput, and malleolus do not warmer, or cooler as compared to have subcutaneous tissue and these adjacent tissue. Stage I may be Adipose tissue ulcers can be shallow. Stage IV ulcers Adipose tissue difficult to detect in individuals with can extend into muscle and/or Muscle dark skin tones. May indicate "at supporting structures (e.g., fascia, Muscle risk" persons (a heralding sign of Bone tendon, or joint capsule) making risk). osteomyelitis possible. Exposed bone/ Bone tendon is visible or directly palpable. STAGE II DEEP TISSUE INJURY Partial thickness loss of dermis Blister Purple or maroon localized area of Reddened area presenting as a shallow open ulcer discolored intact skin or blood-filled Epidermis with a red pink wound bed, without Epidermis blister due to damage of underlying soft slough. May also present as an tissue from pressure and/or shear. The intact or open/ruptured serum-filled Dermis area may be preceded by tissue that is Dermis blister.