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The major elements of the cardiac exam include observation, palpation and, most importantly, auscultation (percussion is omitted). As with all other areas of the physical exam, establishing adequate exposure and a quiet environment are critical. Initially, the patient should rest supine with the upper body elevated 30 to 45 degrees. Most exam tables have an adjustable top. If not, use 2 or 3 pillows. Remember that although assessment of pulse and blood pressure are discussed in the vital signs section they are actually important elements of the cardiac exam.
his patient had spilled boiling water on his lower leg a couple days before. This isn't complicated but the teaching points should focus on draining the large blistered areas and attempting to maintain moisture as long as we can so the skin doesn't contract down on itself.
"I’m essentially taking care of the baby right now to give them 60 or 70 or 80 years of life so I have to perform my best every time. Every single time. That is a commitment that I have to the parents."
The highest standard. That’s what cardiothoracic surgeon Sergio Carrillo demands of himself every time he steps into the OR. Dr. Carrillo and his Heart Center team at Nationwide Children’s Hospital treat patients with congenital heart disease with the simplest to the most complex procedures.
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This is a surgery showing the removal of a large exostosis. Exostoses are bony growths in the ear canal from chronic exposure to cold water/air, most commonly from surfing. This patient had growths in both ears, which were completely obstructing the ear canals. This patient had a single exostosis that was blocking this side (the right side).
Shut the front door: Scientists have finally found the perfect breasts. No, they weren't hiding in the Amazon or roving solo across the Sahara (although we have no doubt there are women in both the Amazon and the Sahara who have magnificent mammaries); it turns out these perfect breasts were hiding in a plastic surgeon's office this whole time! Now, before you get all worked up, the American Society of Plastic Surgeons (ASPS) would like you to know that the super-fake looking plastic breasts of yore are not actually what people think are most attractive now. According to a study published in the Journal of Plastic and Reconstructive Surgery—which involved asking over 1,300 people to look at pictures of naked boobies and rank them by hotness (stop laughing, this is serious research!)—people preferred a more "real" and "normal" look from their silicone, with the ideal breast shape having a 45:55 ratio. People said the best chests have 45 percent of the fullness above the nipple line and 55 percent of the fullness below, in a slightly teardrop shape. Researchers noted this preference remained consistent across gender, racial, and ethnic groups with the 45:55 ratio favored by 87 percent of women in their 30s, 90 percent of men, and 94 percent of plastic surgeons.
ow does a perforation of the eardrum occur? There are many ways an eardrum perforation can occur. An infection behind the eardrum in the middle ear may cause a rupture of the eardrum. Trauma to the ear may result from an object entering the ear canal and puncturing the eardrum. A traumatic blow to the ear with a cupped hand can rupture the eardrum. Hot welding slag can burn a hole through the eardrum. After a ventilation tube has been extruded or is removed, the opening usually closes; in some cases a permanent opening of the eardrum may occur. Chronic ear problems such as deep retraction pockets and cholesteatoma can weaken and erode the eardrum, resulting in a defect or perforation.
There are two main purposes of an arterial line. Firstly when patients are very sick an arterial line is inserted to provide constant monitoring and recording of the patient's blood pressure. Secondly some patients require frequent blood tests and the arterial line provides easy access to a patient's blood.