💢A Airway

🔹airway may be compromised due to:

▪︎Blood or swelling in the airway

▪︎Vomit or secretions

▪︎Reduced consciousness


🔹Clinical assessment

▪︎Can the patient talk? 

•Yes ➡️ Patent Airway
•No ➡️ Check Airway 👇

1) Look for signs of airway compromise:
•cyanosis
•see-saw breathing
•use of accessory muscles
•diminished breath sounds
•added sounds (Stridor)

2) Open the mouth and inspect: look for anything obstructing the airway such as secretions or a foreign object

3) Interventions

▪︎Head-tilt chin-lift manoeuvre
•If No Spine Injury
•Push head to the back
•Pull chin Downward

▪︎Jaw thrust Maneuver
•If there is Spine Injury

▪︎Oropharyngeal Tube
▪︎Nasopharyngeal Tube

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💢B Breathing

▪︎Check the patient’s respiratory rate
▪︎Check the patient’s oxygen saturations

▪︎Look for signs of 
•cyanosis
•respiratory distress
•use of accessory muscles
•abnormal breathing patterns

▪︎Assess for equal chest expansion with respiration and for any obvious chest wall trauma.

▪︎Palpate the position of the patient’s trachea

▪︎Assess for any chest wall tenderness

▪︎Auscultate both lungs for
•good air entry throughout the chest
•added sounds such as crackles and wheeze

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💢C Circulation

▪︎Check the patient’s heart rate & blood pressure

▪︎Assess temperature:
•the hands should be symmetrically warm, indicating adequate perfusion.

•Cool hands indicate poor peripheral perfusion (e.g. hypovolaemic shock).

•Pallor or mottled skin: commonly associated with hypovolaemic shock (e.g. haemorrhage)

▪︎Measure capillary refill time (CRT):
•should return to its normal colour in less than two seconds

▪︎Assess the patient’s radial and brachial pulse to assess rate, rhythm, volume and character

▪︎Auscultate the patient’s precordium to assess heart sounds, listening for evidence of murmurs.

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💢D Disability

▪︎Assess the patient’s level of consciousness by using the Glasgow Coma Scale (GCS).


▪︎Assess if the patient is orientated to person, place and time.


▪︎Assess the patient’s pupils:

•Assess the size and shape of the patient’s pupils.

•A normal pupil diameter ranges from two to five millimetres.

•Assess the pupils for both direct and consensual response to light using a pen torch.

•An oval-shaped pupil, sluggish reaction to light, “blown pupil” or deviated pupil suggests raised ICP or herniation.

•Bilaterally small or “pinpoint” pupils may be due to opioid toxicity.


▪︎Perform a neurological examination in patients who are able to follow commands, assessing:

•Cranial nerves

•Power in each limb

•Sensation in each limb

•Cerebellar function

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❇️Clinical features of raised ICP

▪︎Headache

▪︎Nausea and vomiting

▪︎Restlessness, agitation or drowsiness

▪︎Slow slurred speech

▪︎Papilloedema

▪︎Ipsilateral sluggish dilated pupil which then becomes fixed (“blown pupil”)

▪︎Cranial nerve palsy (e.g. CN III palsy with ‘down and out’ pupil)

▪︎Seizures

▪︎Reduced GCS

▪︎Abnormal respiratory pattern

▪︎Abnormal posturing, initially decorticate and then decerebrate

▪︎hypertension

▪︎bradycardia

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❇️Signs of skull fractures

▪︎CSF (clear fluid) leaking from nose or ear

▪︎Raccoon (Panda) eyes: bruising around the eyes (Fracture of the base of the skull)

▪︎Battle sign: bruising behind the ear over the mastoid process (Fracture in the posterior Cranial Fossa)

▪︎Haemotympanum: blood noted behind the tympanic membrane on otoscopy
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❇️Truma Basics History & Examination 👆👆

#clinical  #surgery
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Middle Age Female patients coming complaining of Chronic epigastric pain for 6 months

- What's obvious clinical sign? And What's the clinical suspecting of this case ?"



"مريضة في منتصف العمر تشتكي من ألم مزمن في منتصف البطن (فوق المعدة) منذ 6 أشهر.

ما العلامة السريرية الواضحة؟
وما هو الاشتباه السريري في هذه الحالة؟

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Troisor sign (Enlargment in left supraclavicular Lymph Node) indicating to GIT cancer especially Gastric cancer

#Remember..
♦️ Virchow's node ♦️
Metastatic tumor to left supraclavicular node (usually due to gastric cancer)

–––––––––––––––
#Answer of the case
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📍Patient WITH peptic ulcer, now SUFFER FROM sever abdominal pain.

📝Chest x ray erect position showing bilateral air under diaphragmatic.

🔎 Bilateral perforation peptic ulcer.
Ddx bilateral perforation of hollow organs.

#Radiology
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📌Patient PRESENT WITH headache, fever.
💥P. M. Hx otitis media, diabetes mellitus.

📝In CT scan axial section of the brain showing left side regular border well define mass hypodensity from inside
WITH midline deviation to other side.

✏️Dignosis left side Brain abscess.
#Radiology
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♦️ Parkland formula:
Use for measuring the amount of Fluid replacement in Burns

Children have a relatively larger proportion of body surface area in their head and neck, which is compensated for by a relatively smaller surface area in the lower extremities.

− In infants: Head and neck- 21%Q ; Each leg- 13%

https://t.me/M_Information11

🪝Double J ;

  🎭 Def ;
It is a thin flexible plastic tube , that is temporarily placed in the ureter to help urine drain from the kidney into the bladder in case of blockage..


           
  🎭Indications =>

            1. Obstructed anuria
            2. Pyonephrosis
            3. Pre _ ESWL
            4. Open surgery
            5. Pelvic trauma
            6. Reconstructive surgery



🎭 How to insert Double J ?
        _  Under general anesthesia,  By using fluorscope & guid wire =>
One J is placed in the renal pelvis & the other one in the bladder



🎭CI =>
         _ Avulsion of ureter


🎭 Complications;
            _ Hematuria
            _ Infection
            _  Encrystation
            _ Vesico_ureteric reflex
            _ Stent fracture
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A Cullen’s sign (near the Umbilicus)
B Gray turner sign (at the flanks)

possibly ▶️ haemorrahgic pancreatitis.

Do Amylase or lipase blood test.

#Surgery_rotation
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دعواتكم لغزة في هذا اليوم الفضيل