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Looking for the onlinemeded quicktables ebook. If anyone has it in Christy Aguilar attached piedalt. Onlinemeded for clinical videos But, i'd rather you have an awesome, well produced, ring bound, color book for cheaper than doing it yourself. Kaplan Pulmonology Videos Vopereq from yt3. This site is purely for educational purposes; All of dustyn's clinical whiteboards, printed in full color, with plenty of room to take your own notes.
Onlinemeded quick tables book on amazon. Confessions of an operating room nurse: All of dustyn's clinical whiteboards, printed in full color, with plenty of room to take your own notes. It presents as pain on defecation that lasts for hours. A physical exam which may need to be done under anesthesia will reveal the fissure. Try sitz baths, NTG paste, or Botulism. After that fails and it usually does , do a lateral internal sphincterotomy to release the tension.
An anal pap can be done for high risk patients. Diagnosis is made by biopsy. Treat with the Nigro Protocol chemo- radiation followed by resection if necessary, usually surgery is not needed. Pilonidal Cyst An abscess of an infected follicle found on the small of the back. Treat with drainage followed by resection. It improves with antacids. This is a medical Pt: Burning retrosternal CP worse when laying down, bad problem treated first with Proton Pump Inhibitors and taste in the mouth, better with antacids lifestyle adjustments.
Cancer adeno requires resection. Options are dilate with a balloon, Tx: Dilation, Botox, Myotomy is best relax with botox, or cut the sphincter with a Heller Myotomy.
Treatment is resection. Treat a GI bleed if the person is still bleeding. Boerhaave An esophageal perforation caused by prolonged retching. The Path: Full thickness mucosal tear, mediastinitis patient will be sick. Do a gastrografin swallow first water soluble to Tx: Surgical Repair prevent mediastinal irritation. If negative, follow with a barium swallow. Conclusive diagnosis and hopeful therapy can be made with EGD. Surgical repair is definitive. Perforation Esophageal perforation is a full thickness tear through all layers of the esophagus.
It can occur from something as simply as a chicken bone, though iatrogenic is by far the most common cause. Treat it like a Boerhaave. Gallbladder Means Gallstones Except for the obstructive jaundice section, gallbladder pathology generally means gallstones. Normal Anatomy of the Asx Gallstones present, Gallstones Hepatobiliary system without obstruction Gallstones occur in females who are fat, forty, and fertile they have four or five kids , and fNative American the F is silent.
Generally, asymptomatic gallstones are left alone. Symptomatic gallstones present with a colicky RUQ abdominal pain that may radiate to the right shoulder and occur after a big fatty Neg Dz Pos Dz meal. Symptoms are typically self-limited. An ultrasound diagnoses it. An elective cholecystectomy can be done if the patient desires. Acute Cholecystitis. Gallstone HIDA scan.
Normal on left has Acute Cholecystitis lodges in Cystic Duct, inducing tracer throughout biliary system. When a gallstone gets in the cystic duct and stays there an Inflammation of the Gallbladder.
Obstruction on right prevents filling inflammatory process develops. Positive study. There should be a Murphy's sign. Diagnose with an ultrasound showing pericholecystic fluid, thickened gallbladder wall, and gall stones. Equivocal cases can be confirmed with a HIDA scan. Emergent cholecystectomy is required perc drainage is an option. Ascending Cholangitis and Choledocholithiasis Choledocholithiasis. Gallstones Pancreatitis. Eventually the enzymes only. No antibiotics are needed.
With multiple Compression etiologies, history and presentation will often clinch the Diabetic diagnosis. Stage of lesion is important for documentation and Ulcer Arterial Insufficiency therapy. Ulcers are treated by correcting the underlying pathology, debriding necrotic tissue to keep a clean ulcer base, Venous Stasis good wound care, and antibiotics only for cellulitis. Epidermis It occurs at areas where bone comes close to the skin sacrum, Dermis knee, and ankle. The patient should be rolled frequently to Fascia alleviate pressure.
The treatment is the same idea: keep pressure Muscle off the wound with rolling, air mattresses, etc. Theoretically blood glucose control, elevation, and Stage IV: Muscle or Bone cleaning of the wounds will help them heal. In reality, these ulcers often lead to amputations. Claudication may be secondary to tight Heel present. Do an ultrasound Doppler to check for macrovascular or injured feet disease.
If there are arteriography no good vessels microvascular disease then amputate. Edema causes Cilostazol compression.
The skin will be edematous, indurated, and Venous Edematous, Above Compression hyperpigmented indicative of long-standing edema , called Stasis hyperpigmented, Medial Stockings stasis dermatitis.
The ulcer is almost always above the medial Indurated Skin Malleolus malleolus. It occurs at sites of a chronic sinus draining tract or on a wound that heals and breaks down over and over again like a 3rd degree burn or radiation. Confirm with a biopsy and treat with wide excision.
These are covered in depth in the medicine topics. There will be an elevated EtOH Hepatitis conjugated bilirubin in obstructive jaundice. Other signs of obstruction may Childhood Disease be present pruritus or icterus, for example but the patient is going to be yellow jaundice. The decision is if it is an acute PostHepatic Gallstones inflammatory process or a chronic malignant one.
The next step is an Ultrasound: a thin walled, dilated gallbladder walls free of inflammation with a distal obstruction cancer , while a thick-walled rigid porcelain gallbladder is from chronic inflammation. In addition, it might even be possible to see the stones in the gallbladder but rarely, if ever, the offending stone. Mild dilation of ducts on ultrasound, Normal Gallbladder Cancer Choledocholithiasis gallstones in the gallbladder you rarely see the gallstones in the duct , and jaundice will be seen.
Weight Loss Migratory Thin-walled, Cancer There are three tumors that can present with painless jaundice, and Jaundice Thrombophlebitis distended a palpable gallbladder, and usually weight loss. It carries a dismal prognosis. Every patient should be on tele in recovery and high risk patients should stay EKG for 1 night for monitoring. DO NOT give clot busters. Confirm the diagnosis with a CT scan. Prevention is key. If aspiration combative patient, emergency surgery is suspected treat with abx that cover gram neg and anaerobes.
Hypoxia can do it and is a simple fix give O2 and Altered intubate as needed. PEEP Benzos Renal Complications Beyond infection there are only a few diseases to consider; they are all based upon how much urine is being made. Leave a Foley in place if two in-and-out caths Yep are required. Vs Nope Foley 2 Zero Output means a mechanical obstruction or post-renal failure.
Anuria is rare unless BOTH ureters are cut. Unkink Renal Failure the catheter and urine will flow. See nephrology for details. But first, just do a cc Fluid cc bolus challenge. If dehydrated, Urine Output will Obstruction Challenge increase slightly with the bolus. Mucking around in the gut can cause some problems.
Given the situation, it should be possible to determine which of these is going on: 1 Paralytic Ileus is expected post-op. Ileus is common on the first day but should subside with ambulation and diet. An upright and flat KUB should show diffuse enlargement of small and large bowel. Watch for hypokalemia - a common cause of ileus. A contrast swallow CT could also be done to see if tracer material passes the obstruction to confirm.
Ultimately, this patient goes back to the OR. Their colon only will be very dilated, shown on a flat and upright KUB. Do a colonoscopy to rule out cancer and to decompress the abdomen two for one deal. Leave a rectal tube in place. Ogilvie Syndrome 1 Dehiscence. The skin is intact but the fascia has failed. If dressings are unusually soaked or have a salmon-color blood and peritoneal fluid look sort of pink think dehiscence. Evisceration must be prevented.
Bind the abdomen and limit movement and straining. This is how patients get ventral hernias. Elective surgical repair is the treatment. The wound pops open and the bowel pops out. This is an emergency. Cover the bowel with warm saline dressings and get back to the OR. Absolutely never push it back in. Absolutely never use dry dressings. Fistulas Fistulas are defined as a connection between two epithelialized surfaces. When they exist consider what has kept them open.
Radiating to the Back Complications and sequella, however, are a surgical topic. The CT scan CAN be used to make the diagnosis of complications, but it should be reserved until after the complications are seen. Surgery can be done later, a necrosectomy after the Pancreatitis BUT fluid collection has solidified.
The first is that necrotizing pancreatitis who is ill and stays ill. This is why serial Necrotizing CT scans become part of the treatment. But for the person with Pancreatitis typical pancreatitis, an abscess will show on day 5 ish with persistent fever and leukocytosis.
When found, they need to be Drain Abscess drained. The best is percutaneous; if severe, drain them Poor Prognosis surgically. A late sequelae is a pseudocyst - so named because it does not have an endothelial lining.
In someone with mass symptoms dyspnea, ascites, and Pseudocyst early satiety , after acute pancreatitis suspect a pseudocyst. Get a CT scan. They need to be drained: to the skin percutaneous , the GI tract cystogastrostomy , or surgically open. Chronic Pancreatitis Patients present with chronic pain that mimics acute pancreatitis. Give the patient Oxygen, Dantrolene, Cooling Blankets, and watch for myoglobinuria i.
Do a CXR and listen to the lungs. If O2 positive, give spirometry to improve ventilation. Do prophylactic incentive spirometry always. First, do a CXR to see Heparin consolidation. If they can pee on their own, surgery! A Exam 2 cm greater on one leg compared to the other is highly suggestive. Anticoagulate with Low Molecular Weight Heparin bridge to warfarin. Prophylax with early mobilization and heparins. A good closure and good wound care could prevent this.
Treat with antibiotics. If erythematous, warm AND boggy, drain the abscess. If not sure, an Ultrasound can be done to clarify. Deep Abscess Wound Someone messed up. Emergent Surgeries are Glucose. However, subacute and elective procedures may be more harmful than the condition they intend to treat. Both add up to one thing: pump failure. Rates of perioperative complication, especially the Aortic Stenosis 3 presence of JVD, are the worst prognostic factor on the index.
If not, optimize the patient medically. Low EF is bad. Low EF and wet is worse. Any patient with an existing pulmonary disease smoker, Smoking Smoke COPD, fibrotic lung, asthmatic should be evaluated. You can give oxygen during surgery, so CO2 retention is worse than low oxygen.
Child-Pugh Smoking Cessation should be started 8 weeks before surgery 1 2 3 because congestion initially worsens and bronchodilators Encephalopathy None A little A lot should be given to optimize FEV1 at the time of surgery.
Its intent is for tracking the liver; surgeons use the Childs-Pugh to put into determination of who should get a liver transplant, though it can a category for a one-time assessment for surgery. The goal of therapy is vigorous nutritional support: PO is better than IV and 10 days is better than 5 days.
If someone is ever peritoneal rebound tenderness, involuntary guarding they go to surgery. Late, Obstruction the distal intestines decompress while the proximal bowel Incomplete Surgery Surgery Emergently swells.
If they have an incomplete obstruction do serial exams and attempt conservative measures fluids, potassium and NG tube decompression. Hernias Hernias are just a wall defect that intestines can move through. Question is: When do Hernias go to OR? Direct hernias are groin hernias of adults that pass directly 1. Femoral hernias are groin hernias pass under the inguinal Question is: What type is it? Reducible is considered elective, incarcerated urgent. If the incarcerated hernia turns strangulated, with obvious peritoneal signs and an affected hernia, it becomes a surgical emergency Reducible Elective Elective requiring emergent Ex-Lap.
Go straight to treatment surgery. If unsure, get a CT scan while preparing the OR. For the test, if the diagnosis is Periumbilical Pain obvious go straight to surgery. Carcinoid produces serotonin. Intestinal serotonin is degraded by the liver. With mets to the and peritoneal signs liver, serotonin goes to the R heart causing fibrosis, flushing, Negative? The lungs degrade serotonin sparing Vague symptoms Physical the L heart, releasing 5-HIAA to be excreted into the urine; it is worrisome for Exam Inflammation used as a screening tool for the cancer.
It must be staged and resected. A particular variant, consider an embolic or even thrombotic occlusion of the acute narrow angle glaucoma, is caused by fluid being trapped retinal artery. If you see cherry-red spots on the fovea, the in the anterior chamber. After a patient has spent a prolonged diagnosis is made.
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