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Mantke, Peitz, Surgical Ultrasound -- Index
419 Index A esophageal 218 Anorchidism 376 gallbladder 165 Aorta 364–366 A-mode imaging 97 gastric 220 abdominal aneurysm (AAA) AAA (abdominal aortic aneurysm) metastasis 142 20–21, 364, 366 20–21, 364, 366 pancreatic 149, 225 dissection 364, 366 Abdominal wall Adenofibroma, breast 263 perforation 366 abscess 300–301 Adenoma pseudoaneurysm 364 diagnostic evaluation 297 adrenal 214 Aortic rupture 20 hematoma 73, 300, 305 colorectal 231, 232 Aplasia, muscular 272 rectus sheath 297–300 duodenal papilla 229, 231 Appendicitis 1–4 hernia 300, 302–304 gallbladder 165 consequences for surgical indications for sonography 297 hepatic 54, 58, 141 treatment 2 seroma 298, 300, 305 multiple 141 sonographic criteria 1 trauma 297–300 parathyroid 213 Archiving 418 Abortion, tubal 30 renal 241 Arteriosclerosis 346, 348 Abscess thyroid 202–203 carotid artery 335, 337, 338 abdominal wall 300–301 Adenomyomatosis 8, 164, 165 plaque 337, 338, 345, 367, 370 causes 301 Adrenal glands 214–216 Arteriovenous (AV) malformation amebic 138 adenoma 214 139, 293, 326–329 breast 264 carcinoma 214 Artery chest wall 173, 178 cyst 214 carotid 334–339 diverticular 120, 123 hematoma 214 aneurysm 338 drainage 85–88, 93 hemorrhage 214 arteriosclerosis 335 hepatic 6, 138, 398 hyperplasia 214 plaque characteristics inflammatory bowel disease limpoma/myelipoma 214 337, 338, 345 116, 119 metastases 214 bifurcation 334, 337 intramural 5 sonographic criteria 214 bulb 339 lung 183, 186, 190 tuberculosis 214 dissection 338, 339, 346 pancreatic 11 Advanced dynamic flow (ADF) sonographic -
Clinical Excellence Series Volume VI an Evidence-Based Approach to Infectious Disease
Clinical Excellence Series n Volume VI An Evidence-Based Approach To Infectious Disease Inside The Young Febrile Child: Evidence-Based Diagnostic And Therapeutic Strategies Pharyngitis In The ED: Diagnostic Challenges And Management Dilemmas HIV-Related Illnesses: The Challenge Of Emergency Department Management Antibiotics In The ED: How To Avoid The Common Mistake Of Treating Not Wisely, But Too Well Brought to you exclusively by the publisher of: An Evidence-Based Approach To Infectious Disease CEO: Robert Williford President & Publisher: Stephanie Ivy Associate Editor & CME Director: Jennifer Pai • Associate Editor: Dorothy Whisenhunt Director of Member Services: Liz Alvarez • Marketing & Customer Service Coordinator: Robin Williford Direct all questions to EB Medicine: 1-800-249-5770 • Fax: 1-770-500-1316 • Non-U.S. subscribers, call: 1-678-366-7933 EB Medicine • 5550 Triangle Pkwy Ste 150 • Norcross, GA 30092 E-mail: [email protected] • Web Site: www.ebmedicine.net The Emergency Medicine Practice Clinical Excellence Series, Volume Volume VI: An Evidence-Based Approach To Infectious Disease is published by EB Practice, LLC, d.b.a. EB Medicine, 5550 Triangle Pkwy Ste 150, Norcross, GA 30092. Opinions expressed are not necessarily those of this publication. Mention of products or services does not constitute endorsement. This publication is intended as a general guide and is intended to supplement, rather than substitute, professional judgment. It covers a highly technical and complex subject and should not be used for making specific medical decisions. The materials contained herein are not intended to establish policy, procedure, or standard of care. Emergency Medicine Practice, The Emergency Medicine Practice Clinical Excellence Series, and An Evidence-Based Approach To Infectious Disease are trademarks of EB Practice, LLC, d.b.a. -
Chest Radiology: a Resident's Manual
Chest Radiology: A Resident's Manual Bearbeitet von Johannes Kirchner 1. Auflage 2011. Buch. 300 S. Hardcover ISBN 978 3 13 153871 0 Format (B x L): 23 x 31 cm Weitere Fachgebiete > Medizin > Sonstige Medizinische Fachgebiete > Radiologie, Bildgebende Verfahren Zu Inhaltsverzeichnis schnell und portofrei erhältlich bei Die Online-Fachbuchhandlung beck-shop.de ist spezialisiert auf Fachbücher, insbesondere Recht, Steuern und Wirtschaft. Im Sortiment finden Sie alle Medien (Bücher, Zeitschriften, CDs, eBooks, etc.) aller Verlage. Ergänzt wird das Programm durch Services wie Neuerscheinungsdienst oder Zusammenstellungen von Büchern zu Sonderpreisen. Der Shop führt mehr als 8 Millionen Produkte. 1 Heart Failure Acute left heart failure is most commonly caused by a hyperten- " Compare pulmonary vessels that are equidistant to a central sive crisis. Radiographic signs on the plain chest radiograph ob- point in the respective hilum. tained with the patient standing include: " Compare the diameter of a random easily identifiable superior " Redistribution of pulmonary perfusion lobe artery (often the anterior segmental artery is most easily " Presence of interstitial patterns (Kerley lines, peribronchial identifiable) with the diameter of the corresponding ipsilateral cuffing) bronchus (Fig. 1.62). " Alveolar densities with indistinct vascular structures (ad- vanced stage) As the pulmonary artery and corresponding ipsilateral bronchus " Pleural effusions are normally of precisely equal diameter, a larger arterial diameter is indicative of redistribution of perfusion (Fig. 1.63). The diagnos- All of these signs are essentially attributable to increased fluid tic criteria of caudal-to-cranial redistribution cannot be evaluated content in the abnormally heavy “wet” lung. The fluid accumula- on radiographs obtained in the supine patient. -
Common Pediatric Pulmonary Issues
Common Pediatric Pulmonary Issues Chris Woleben MD, FAAP Associate Dean, Student Affairs VCU School of Medicine Assistant Professor, Emergency Medicine and Pediatrics Objectives • Learn common causes of upper and lower airway disease in the pediatric population • Learn basic management skills for common pediatric pulmonary problems Upper Airway Disease • Extrathoracic structures • Pharynx, larynx, trachea • Stridor • Externally audible sound produced by turbulent flow through narrowed airway • Signifies partial airway obstruction • May be acute or chronic Remember Physics? Poiseuille’s Law Acute Stridor • Febrile • Laryngotracheitis (croup) • Retropharyngeal abscess • Epiglottitis • Bacterial tracheitis • Afebrile • Foreign body • Caustic or thermal airway injury • Angioedema Croup - Epidemiology • Usually 6 to 36 months old • Males > Females (3:2) • Fall / Winter predilection • Common causes: • Parainfluenza • RSV • Adenovirus • Influenza Croup - Pathophysiology • Begins with URI symptoms and fever • Infection spreads from nasopharynx to larynx and trachea • Subglottic mucosal swelling and secretions lead to narrowed airway • Development of barky, “seal-like” cough with inspiratory stridor • Symptoms worse at night Croup - Management • Keep child as calm as possible, usually sitting in parent’s lap • Humidified saline via nebulizer • Steroids (Dexamethasone 0.6 mg/kg) • Oral and IM route both acceptable • Racemic Epinephrine • <10kg: 0.25 mg via nebulizer • >10kg: 0.5 mg via nebulizer Croup – Management • Must observe for 4 hours after -
Radiologic Assessment in the Pediatric Intensive Care Unit
THE YALE JOURNAL OF BIOLOGY AND MEDICINE 57 (1984), 49-82 Radiologic Assessment in the Pediatric Intensive Care Unit RICHARD I. MARKOWITZ, M.D. Associate Professor, Departments of Diagnostic Radiology and Pediatrics, Yale University School of Medicine, New Haven, Connecticut Received May 31, 1983 The severely ill infant or child who requires admission to a pediatric intensive care unit (PICU) often presents with a complex set of problems necessitating multiple and frequent management decisions. Diagnostic imaging plays an important role, not only in the initial assessment of the patient's condition and establishing a diagnosis, but also in monitoring the patient's progress and the effects of interventional therapeutic measures. Bedside studies ob- tained using portable equipment are often limited but can provide much useful information when a careful and detailed approach is utilized in producing the radiograph and interpreting the examination. This article reviews some of the basic principles of radiographic interpreta- tion and details some of the diagnostic points which, when promptly recognized, can lead to a better understanding of the patient's condition and thus to improved patient care and manage- ment. While chest radiography is stressed, studies of other regions including the upper airway, abdomen, skull, and extremities are discussed. A brief consideration of the expanding role of new modality imaging (i.e., ultrasound, CT) is also included. Multiple illustrative examples of common and uncommon problems are shown. Radiologic evaluation forms an important part of the diagnostic assessment of pa- tients in the pediatric intensive care unit (PICU). Because of the precarious condi- tion of these patients, as well as the multiple tubes, lines, catheters, and monitoring devices to which they are attached, it is usually impossible or highly undesirable to transport these patients to other areas of the hospital for general radiographic studies. -
Respiratory Distress in Pediatrics
Hindsight is 20/20 Karen A. Santucci, M.D. Professor of Pediatrics Yale-New Haven Children’s Hospital October 9, 2014 Disclosure No Financial Relationships Personal Financial Disclosure Case 1 Toddler siblings are jumping on the couch Larger one lands on top of the smaller one, both landing on the tile floor The smaller child cries out and develops respiratory distress. 911 activated Vitals: RR 62, HR 168, afebrile, crying EMS is transports her to the nearest hospital Case Progression Upon arrival, oxygen saturation in 70’s and severe respiratory distress Supplemental oxygen not helping! Decreased breath sounds bilaterally! No reported tracheal deviation Difficult to ventilate and oxygenate! Bilateral chest tubes are placed! She’s Intubated! Still difficult to ventilate and oxygenate! Case Progression Differential Diagnoses? Differential Diagnoses? Pulmonary contusion? Traumatic pneumothorax? Hemothorax? Crush injury? Transection? Underlying problem????? -Asthma -Pneumonia -Cystic fibrosis Perplexing Case Pediatric Pearl If it doesn’t make sense, go back to the basics. What were they doing right before the fall? Something We Don’t See Everyday! or Do We???? What the Heck!! Epidemiology 92,166 cases reported to Poison Centers in 2003 Peak incidence 6 months to 3 years 600 children die annually Majority present to EDs 2003 Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System Am J Emerg Med 2004; 22:335-404 Foreign Bodies Food Coins Toys Munchausen Syndrome by -
Chronic Cough- Whoop It
3/3/2016 Chronic Cough- Whoop it Cassaundra Hefner PULMONARY ANATOMY DNP, FNP-BC FryeCare Lung Center Upper Airway Nasopharynx Oropharynx Laryngopharynx Lower Larynx Trachea Bronchi Bronchopulmonary segments Terminal bronchioles Acinus (alveolar regions) Upper and Lower Airway are lined with cilia which propel mucus and trapped bacteria toward the oropharynx Cough COUGH ACTION Protective reflex that keeps throat clear allowing for mucocilliary clearance of airway secretion Intrathoracic process of air from a vigorous cough through nearly closed vocal cords can approach 300mmHG, the velocities tear off mucus from the airway walls. The velocity can be up to 500mph 4 Cough/Sputum Defense mechanism to prevent aspiration- cough center stimulated- cough begins with deep inspiration to 50 % vital capacity- maximum expiratory flow increases coil - decreasing airway resistance- glottis opens wide and takes in large amount of air - glottis then rapidly closes - abdominal and intercostal muscles contract- increases intrapleural pressure - the glottis reopens- explosive release of air the tracheobronchial tree narrows rips the mucous off the walls = sputum 1 3/3/2016 Chronic Cough Defined (AACP, 2016) Effects of cough that prompts visit Talierco & Umur, 2014 Acute Sub-acute Chronic Fatigue 57% Cough Cough 3-8 Unexplained chronic less than weeks cough(UCC) Insomnia 45% 3 weeks Excessive perspiration 42% Cough lasting greater Incontinence 39% than 8 weeks in 15 yo or older MSK pain 45% Cough lasting greater Inguinal herniation than 4 weeks in Dysrhythmias those under the Headaches age of 15 Quality of life questionnaires are recommended for adolescents and children (CQLQ) Work loss Data Institute (NCG) (2016) Cough Referral to Pulmonology 80%-90% chronic cough Most common symptom for PCP visits in the U.S. -
Retropharyngeal Abscess: Diagnosis and Treatment Update
Infectious Disorders – Drug Targets, 2012, 12, 291-296 291 Retropharyngeal Abscess: Diagnosis and Treatment Update 1 2,3 Brian K. Reilly * and James S. Reilly 1Children’s National Medical Center, Washington, DC; USA; 2Chair, Department of Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA; 3Professor of Otolaryngology and Pediatrics, Thomas Jefferson Univer- sity, Philadelphia, PA, USA Abstract: Retropharyngeal abscess is a deep neck space infection that may present in various subtle ways permitting po- tentially lethal complications to occur before appropriate diagnosis is made and expedient management undertaken. This article reviews in detail the pertinent anatomy, diagnostic pearls, and clinical recommendations to optimally manage these common infections in children. Keywords: Abscess, imaging, infection, neck, pediatric, retropharyngeal. OVERVIEW whether purulence is obtained intra-operatively [3]. Classic findings for abscess include large fluid with central A retropharyngeal abscess (RPA) is a deep neck space hypodensity, complete ring enhancement, and scalloping infection defined by its anatomical location within the deep Fig. (1). cervical tissue planes. RPA is located behind the pharyngeal mucosa and is contained anteriorly by the buccopharyngeal fascia (around the constrictor muscles) and laterally by the carotid sheath/parapharyngeal space. Superiorly, it may ex- tend to the skull base, and inferiorly, it can travel to the me- diastinum. This “potential” retropharyngeal space, which expands with infection, is occupied by a lymph-node basin [1] that serves as the common, final drainage pathway of the nasal cavity, paranasal sinuses, nasopharynx, oropharynx, hypopharynx, and larynx. Inadequately treated and virulent infections of these regions can cause suppuration of these nodes. Thus, retropharyngeal lymphadenitis with edema can progress to a cellulitis, which, if untreated, evolves to early abscess or phlegmon and then to abscess. -
Chest Pain and Cardiac Dysrhythmias
Chest Pain and Cardiac Dysrhythmias Questions 1. A 59-year-old man presents to the emergency department (ED) com- plaining of new onset chest pain that radiates to his left arm. He has a his- tory of hypertension, hypercholesterolemia, and a 20-pack-year smoking history. His electrocardiogram (ECG) is remarkable for T-wave inversions in the lateral leads. Which of the following is the most appropriate next step in management? a. Give the patient two nitroglycerin tablets sublingually and observe if his chest pain resolves. b. Place the patient on a cardiac monitor, administer oxygen, and give aspirin. c. Call the cardiac catheterization laboratory for immediate percutaneous inter- vention (PCI). d. Order a chest x-ray; administer aspirin, clopidogrel, and heparin. e. Start a β-blocker immediately. 2. A 36-year-old woman presents to the ED with sudden onset of left- sided chest pain and mild shortness of breath that began the night before. She was able to fall asleep without difficulty but woke up in the morning with persistent pain that is worsened upon taking a deep breath. She walked up the stairs at home and became very short of breath, which made her come to the ED. Two weeks ago, she took a 7-hour flight from Europe and since then has left-sided calf pain and swelling. What is the most com- mon ECG finding for this patient’s presentation? a. S1Q3T3 pattern b. Atrial fibrillation c. Right-axis deviation d. Right-atrial enlargement e. Tachycardia or nonspecific ST-T–wave changes 1 2 Emergency Medicine 3. -
Don't Overlook Unexpected, but Risky, Diagnoses
® NOVEMBER 2020 VOLUME 15, NUMBER 2 THE JOURNAL OF URGENT CARE MEDICINE ® www.jucm.com The Official Publication of the UCA and CUCM CLINICAL cme ALSO IN THIS ISSUE 19 Original Research Probably Strep Informed Decisions Are Safer ‘ ’ Is Decisions in Patients with Sinusitis cme 29 Case Report Potentially Dangerous— When a Disease ‘of Childhood’ Threatens the Life of an Adult Patient 35 Clinical Don’t Overlook Unexpected, Better to Risk Patient Outrage Than Antibiotic Resistance When Treating but Risky, Diagnoses Otitis Media cme Health Law and Compliance The COVID-19 Vaccine Could Save Lives—and Your Business. But What If Employees Refuse to Get It? Ad_FullPage_Sized.indd 1 10/21/20 3:13 PM URGENT PERSPECTIVES Finding Urgent Care (and the Value of Recognizing a Specialty) n GUY MELROSE, MB, ChB arrived in New Zealand 11 years ago, a doctor without direc- Ition and certainly with no inkling of urgent care. I was one of those doctors who had always hoped to find their ultimate career path whilst at university. Alas, whilst I was able to remove some options (here’s looking at you Ob/Gyn),no single spe- cialty sufficiently inspired me to follow that rabbit hole through to its conclusion. So, my medical career began with an eclectic mix of jobs and travel, mainly focused around the emergency department. Maintaining this level of generalism seemed sensible, until such time as a specialty found me. As a young person, the ED was an exciting and flexible option. Yet in the back of my mind, I always assumed the career that would suit my broad interest in medicine whilst also addressing my growing need for a work-life balance would be general practice (or family practice, as it’s known in the U.S.). -
Post Lung Transplant Complications: Emphasis on CT Imaging Findings
Post Lung Transplant Complications: Emphasis on CT Imaging Findings Rashmi Katre, MD Carlos S Restrepo, MD Ameya Baxi, MD Learning Objectives • To identify the pulmonary complications and pathological processes which may occur after lung transplantation • To describe the role of imaging in post transplant patients with emphasis on the CT imaging findings of the select relevant entities None of the authors has any financial disclosure to make. The authors declare that there is no conflict of interest Introduction • Lung transplantation has been widely accepted as a treatment of choice among patients with end stage lung disease. • Past experiences have shown its efficacy in improving the longevity as well as quality of life in many patients. Nevertheless, it is not devoid of complications which may vary from trivial and treatable entities to life threatening conditions. • The complications can be divided into plural, pulmonary and airway diseases such as; hyperacute, acute, and chronic rejection including bronchiolitis obliterans organizing pneumonia; pulmonary infections; bronchial anastomotic complications; pleural effusions; pneumothoraces, lung herniation, pulmonary thromboembolism; upper-lobe fibrosis; primary disease recurrence; posttransplantation lymphoproliferative disorder. • Imaging , especially CT is crucial in early detection, evaluation and diagnosis of these complications, in order to decrease the morbidity and mortality associated with certain conditions. This educational exhibit addresses the pathological processes after lung transplantation and discusses the role of imaging, with emphasis on CT imaging findings. Reperfusion Edema Ischemia-reperfusion injury is a noncardiogenic pulmonary edema that typically occurs more than 24 hours after transplantation, peaks in severity on postoperative day 4, and generally improves by the end of the 1st week. -
Andrea Kline Tilford Phd, CPNP‐AC/PC, FCCM
Acute Care Pediatric Nurse Practitioner Review Course 2020 Andrea Kline Tilford PhD, CPNP‐AC/PC, FCCM C.S. Mott Children’s Hospital Ann Arbor, Michigan ©202 0 Disclosures • I have no financial relationships to disclose • I will not discuss investigational drug use ©202 0 Objectives • Discuss general principles of pediatric respiratory physiology • Discuss the presentation and evaluation of common pediatric respiratory diseases • Identify appropriate management strategies for common pediatric respiratory diseases ©202 0 Basic Anatomy • Upper Airway • Supraglottic (nose, nasopharynx, epiglottis) • Glottis (vocal cords, subglottic area, cervical trachea) • Humidifies inhaled gases • Warms inhaled gas • Site of most resistance to airflow • Conducting airways (dead space) • Lower airways • Thoracic trachea, bronchi, bronchioles and alveoli (gas exchange) ©202 0 Anatomical Considerations in Children • Pediatrics • Small mouth • Large tongue • In relation to mandible • Floppy epiglottis (infants) • Large occiput • Infants are obligate nose breathers (until ~ 6 months of age) • Cricoid ring narrowest portion of airway in infants and young children ©202 0 Bronchus • Bifurcates into right and left bronchus • RIGHT side generally more straight and more likely to be site of aspiration www.med.umich.edu ©202 0 Alveoli • Continue to multiply until ~ 8 years of age Covered in capillaries Site of gas exchange oac.med.jhmi.edu ©202 0 Basic Physiology • Goal of respiration = Oxygen in and carbon dioxide out • Oxygen ʻinʼ • For cell use • Carbon dioxide ʻoutʼ • Produced by cells ©202 0 Gas Exchange • Inhalation • Active; requires contraction of several muscles (e.g. diaphragm, intercostals) • Exhalation • Passive • Relaxation of intercostals and diaphragm, return of rib cage, diaphragm, and sternum to resting position, increases pressure in lungs and air is exhaled **PEARL: Some conditions, such as status asthmaticus, interfere with passive exhalation.