Basic Cardiovascular Examination PDF Ispis E-mail
E-obrazovanje - Materijali
Autor mtaradi   
Srijeda, 24 Studeni 2010 19:32

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1. This examination is a particularly important skill to master but is also one of the more complex ones. It not only involves a thorough examination of the heart, but also of the hands, face, neck and other areas of the body.
2. Start, as with all examinations, by introducing yourself and explaining to the patient what you plan to do and ensure that you have their consent. Now is a good point to ask the patient to remove their top so that the chest is entirely exposed and place them on the bed with their trunk at 45o.
3. Firstly, you should start by observing the patient from the end of the bed. You should note whether the patient looks comfortable. Are they cyanosed or flushed? Is their respiration rate normal? Are there any clues around the bed such as PCA machines, GTN sprays or an oxygen mask? You should comment on each of the areas to the examiner.
4. Next you should look at the patient’s hands. Initially note how warm they feel as this gives an indication of how well perfused they are. Particular signs which you should be looking for are nail clubbing, splinter haemorrhages, palmar erythema and nicotine staining.
5. Now is a good time to take the radial pulse. It is not a suitable pulse for describing the character of the pulsation, but can be used to assess the rate and rhythm. At this point you should also check for a collapsing pulse – a sign of aortic incompetence. Remembering to check that the patient doesn’t have any problems with their shoulder, locate the radial pulse and place your palm over it, then raise the arm above the patient’s head. A collapsing pulse will present as a knocking on your palm.
6. Examine the extensor aspect of the elbow for any evidence of xanthomata.
7. At this point you should say to the examiner that you would like to take the blood pressure. They will usually tell you not to and give you the value.
8. Next you should move up to the face. Look in the eyes for any signs of jaundice (particularly beneath the upper eyelid), anaemia (beneath the lower eyelid) and corneal arcus. You should also look around the eye for any xanthelasma.
9. Whilst looking at the face, check for any malar facies, look in the mouth for any signs of anaemia such as glossitis, check the colour of the tongue for any cyanosis, and around the mouth for any angular stomatitis – another sign of anaemia.
10. Next, move to the patient’s neck to assess their jugular venous pressure (JVP). Ask them to turn their head to look away from you. Look across the neck between the two heads of sternocleidomastoid for a pulsation. If you do see a pulsation you need to determine whether it is the JVP – if it is then the pulsation is non-palpable, obliterable by compressing distal to it and will be exaggerated by performing the hepatojugular reflex. Having warned the patient that it may cause some discomfort, press down on the liver. This will cause the JVP to rise further. If you decide the pulsation is due to the JVP, note its vertical height above the sternal angle.
11. It is now time to move the examination to the chest, or praecordium. Start by inspecting the area, particularly looking for any obvious pulsations, abnormalities or scars, remembering to check the axillae as well.
12. Palpation of the praecordium starts by trying to locate the apex beat. Start by doing this with your entire hand and gradually become more specific until it is felt under one finger and describe its location anatomically. The normal location is in the 5th intercostals space in the mid-clavicular line. However, it is not uncommon to not feel the apex beat at all.
13. Next you should palpate for any heaves or thrills. A thrill is a palpable murmur whereas a heave is a sign of left ventricular hypertrophy. A thrill feels like a vibration and a heave feels like an abnormally large beating of the heart. Feel for these all over the praecordium.
14. You now move onto auscultation. This is done for all four valves of the heart in the following areas:
* Mitral valve – where the apex beat was felt.
* Tricuspid valve – on the left edge of the sternum in the 4th intercostal space.
* Pulmonary valve – on the left edge of the sternum in the 2nd intercostal space.
* Aortic valve – on the right edge of the sternum in the 2nd intercostal space.
You should listen initially with the diaphragm noting how many heart sounds you can hear – are there any extra to the two normal sounds? Are there any murmurs? Are the heart sounds normal in character? Can you hear any rub? If you hear any abnormal sounds you should describe them by when they occur and the type of sound they are producing. Feeling the radial pulse at the same time can give good indication as to when the sound occurs – the pulse occurs at systole. Furthermore, if you suspect a murmur, check if it radiates. Mitral murmurs typically radiate to the left axilla whereas aortic murmurs are heard over the left carotid artery.
You may also wish to listen with the bell of your stethoscope for any low pitched murmurs.
15. To further check for mitral stenosis you can lay the patient on their left side, ask them to breathe in, then out and hold it out and listen over the apex and axilla with the bell of the stethoscope.
16. Aortic incompetence can be assessed in a similar way but ask the patient to sit forward, repeat the breathe in, out and hold exercise and listen over the aortic area with the diaphragm.
17. Finally you should assess for any oedema. Whilst the patient is sat forward, feel the sacrum for oedema and also assess the ankles for the same.

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Measurement of Blood Pressure PDF Ispis E-mail
E-obrazovanje - Materijali
Autor mtaradi   
Srijeda, 24 Studeni 2010 19:16

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1. Initially, ensure that you have all the necessary equipment. This is a sphygmomanometer, a stethoscope and hand cleaning gel.
Blood Pressure Equipment
2. It is important when measuring blood pressure to build a rapport with your patient so as to prevent 'White Coat Syndrome' which may give you an inaccurately high reading. Therefore, ensure you introduce yourself to the patient, explain the procedure answering any questions they may have, and ask for their consent. You should also explain to them that they may feel some discomfort as you inflate the cuff, but that this will be shortlived. Make sure they are sitting comfortably, with their arm rested.
Introducing yourself
3. Next, as with all clinical procedures, it is vital that you wash your hands with alcohol rub.
Hand Cleaning
4. You should ensure that you have the correct cuff size for your patient. A different cuff size may be required for obese patients and children.
Cuff Size
5. Wrap the cuff around the patient's upper arm ensuring the arrow is in line with the brachial artery. This should be determined by feeling the brachial pulse.
Cuff Placement
6. Next you need to determine a rough value for the systolic blood pressure. This can be done by palpating the brachial or radial pulse and inflating the cuff until the pulse can no longer be felt. The reading at this point should be noted and the cuff deflated.
Estimating the systolic blood pressure
7. Now that you have a rough value, the true value can be measured. Place the diaphragm of your stethoscope over the brachial artery and re-inflate the cuff to 20-30 mmHg higher than the estimated value taken before. Then deflate the cuff at 2-3 mmHg per second until you hear the first Korotkov sound - this is the systolic blood pressure. Continue to deflate the cuff until the sounds disappear, the 5th Korotokov sound - this is the diastolic blood pressure.
Recording the Blood Pressure
8. If the blood pressure is greater than 140/90, you should wait for 1 minute and re-check.
9. Furthermore, you should explain to your examiner that you would want to check the blood pressure standing to check for a significant drop (>20 mmHg after 2 minutes). This would suggest a postural hypotension.
10. Finally, you should give the reading to the patient and thank them.


 
Thyroid examination,clinical skills online PDF Ispis E-mail
E-obrazovanje - Materijali
Autor mtaradi   
Srijeda, 24 Studeni 2010 19:10

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In vertebrate anatomy, the thyroid gland or simply, the thyroid, is one of the largest endocrine glands in the body, and is not to be confused with the "parathyroid glands" (a completely different set of glands). The thyroid gland is found in the neck, inferior to (below) the thyroid cartilage (also known as the 'Adam's Apple') and at approximately the same level as the cricoid cartilage. The thyroid controls how quickly the body uses energy, makes proteins, and controls how sensitive the body should be to other hormones.


 
What is Cancer? - 3D Medical Animation PDF Ispis E-mail
E-obrazovanje - Materijali
Autor mtaradi   
Srijeda, 24 Studeni 2010 18:51

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Any of a group of more than 100 distinct diseases that are characterized by the uncontrolled multiplication of abnormal cells. Cancerous cells and tissues have abnormal growth rates, shapes, sizes, and functioning. Cancer may progress in stages from a localized tumour (confined to the site of origin) to direct extension (spread into nearby tissue or lymph nodes) and metastasis (spread to more distant sites via the blood or lymphatic system). This malignant growth pattern distinguishes cancerous tumours from benign ones. Cancer is also classified by grade, the extent to which cell characteristics remain specific to their tissue of origin. Both stage and grade affect the chances of survival. Genetic factors and immune status affect susceptibility. Triggers include hormones, viruses, smoking, diet, and radiation. Cancer can begin in almost any tissue, as well as in the blood (see leukemia) and lymph (see lymphoma). When it metastasizes, it remains a cancer of its tissue of origin. Early diagnosis and treatment increase the chance of cure. Treatment may include chemotherapy, surgery, and radiation therapy.


 
Zašto je teško položiti fiziologiju? PDF Ispis E-mail
Predah - Anegdote i "biseri"
Autor mtaradi   
Srijeda, 24 Studeni 2010 17:38

Istinita zgoda sa sto sedamdest i nekojeg pokušaja polaganja ispita iz Fiziologije

      Da, nije tiskarska pogreška, radi se o izlasku na ispit po 170 i nekoji put (evidencija nije posve pouzdana!). Kolega uredno prijavljuje ispit na svakom roku, uredno dolazi na ispit, odgovara i uredno pada na ispitu. Nije šala, prvi izlazak na ispit Fiziologije obavio je prije nego što sam se ja rodio. S ispita ne odlazi nikada ljut, neraspoložen ili razočaran, već naprotiv vedar i u uvjerenju da će drugi puta biti bolje. I tako jednom zgodom na početku usmenog ispita, više iz znatiželje i da razbijem tremu upitao sam kolegu:
     - U čemu je problem da toliko puta izlazite na ispit? Je li gradivo preteško ili preveliko?
Odgovor je bio neobičan (zato se i našao u ovoj rubrici :-)
     - Znate, nije problem naučiti fiziologiju, ali se knjiga prečesto mijenja, pa ne stignem! Taman kad naučim cijeli udžbenik, ono izađe novi!
Začuđen, s nevjericom i žaljenjem rekoh:
     - Pa dobro kolega, odovarajte po starom udžbeniku i sve ću Vam priznati. Ionako razlike nisu veće od kojih 15%.
A kolega je ispalio kao iz topa:
     - E da sam ja to znao! Čim je izašao novi udžbenik odmah sam sve zaboravio i počeo učiti ispočetka.
Treba li napomenuti da nažlost ispit još uvijek nije položio.

M.Taradi


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Ažurirano Nedjelja, 19 Prosinac 2010 20:53