- Heel foreign body X-ray.

Heel foreign body X-ray.

A child presented to Mansoura Emergency Hospital by a needle in heel which not appear on the skin,An X-ray was made and shown this..

Dr Ibrahim samaha

- Arterial Doppler Examination.

Arterial Doppler Examination.

An Arterial Doppler evaluates the arterial blood flow of the body. It is used many times to evaluate the arteries of the legs.

It may be ordered when there is suspicion on exam or with symptoms suggestive of blockage of the arteries.

There is no radiation for this test as it uses sound waves and pressure cuffs.

This video shows how to interpret vascular arterial doppler signal wave-forms in a simple and informative fashion.

This is educational especially in teaching how to better utilise a simple hand-held Doppler.

- Adrenergic manifestations of Hypoglycemia.

Adrenergic manifestations of Hypoglycemia

(warning signs of hypoglycemic coma).

Due to release of catecholamines when blood sugar less than 50mg%.

"chat Msn"

Coldness, Clamminess
Hunger pain.
Anxiety
Tachycardia,Tremors.


Mydriasis (Dilated pupils).
Sweating.
Nervousness

enjoy,,

Dr Ibrahim

- Renal trauma grading scale.

Basically we can divide renal trauma into five grades.

The grades I , II and III are classified as minor traumas, and the grades IV,V as major :-

• Grade I: contusion or subcapsular hematoma, without parenchymal laceration.
• Grade II: superficial cortical laceration less than 1 cm deep.
• Grade III: deep cortical laceration extending more than 1 cm.
• Grade IV:
1. corticomedullary laceration with collecting system injury and urinary extravasation. 
2.  vascular injury:- laceration or thrombosis of a segmental artery.

• Grade V:
1. Multiple deep lacerations.
2. Thrombosis of the main renal artery.
3. Avulsion of renal hilum which devascularizes kidney.

- Bladder Injury.

Bladder Injury

Aetiology:-

1. Blunt trauma : 10% of pelvic fractures.
2. Penetrating trauma :gunshots or stap wounds.
3. Iatrogenic:-
• Obestetric :- 0.3% with caeserean section.
• Gynaecological e.g.during a vaginal or abdominal hysterectomy.
• Urological e.g during cystescopy.
• Orthopaedic e.g. pins and screws can commonly perforate the urinary bladder, particularly during internal fixation of pelvic fractures.
4. Idiopathic:- due to presence of a previous scar.

Classification(Pathophysiology):-

1. Extraperitoneal rupture bladder:
Usually due to fracture pelvis,and Extravasation occur at the perivesical space and may extend up to the anterior abdominal wall,If the urogenital membrane is injuried.
2. Intraperitoneal rupture bladder:(The most dangerous)
Usually due to direct trauma when the bladder is full,associated with electrolyte disturbance and may passed unnoticed for along time.

- Arterial line placement.

Arterial line placement.

An intra-arterial catheter (A-line) is a very small plastic tube (called catheter) placed in one of your blood vessels (an artery) by highly trained personnel. This is usually done during or before certain types of surgery or in the Intensive Care Unit.

To see how to undergo Arterial line see the following video from New Engeland Journal of Medicine.

you can see the video online on NEJM here or

Download it directly from here 

  or watch it now :D

-Poisons with charachteristic odour.

Poisons with charachteristic odour

"Phenol"

Phenol,Phosphorus.

Hydrocarbons.
Hydrocyanic acid(Bitter almond).
Hydrogen sulphide(Rotten egg).

Ethanol and methanol.
Nicotine.

Opium.
Organophosphorus,arsenic (Garlic odour).

Liquid of salicylate"oil of winter green".

Dr Ibrahim

-Indications of heamodialysis.

Indications of heamodialysis
"Unstable"

Uraemia.
No response to conventional therapy.
Salicylates.
Theophylline.
Alcohols,Acetaminophen.
Boric acid,Barbiturates.
lithium.
Ethylene glycol.

Dr Ibrahim

-Substances not adsorbed by Activated Charcoal.

Substances not adsorbed by Activated Charcoal
"Phials"

Pesticide,potassuim
Hydrocarbons.
Iron,Insecticide.
Acids,Alkali,Alcohols.
Lithium.
Solvents.

Dr Ibrahim

-Common radiopaque medications.

Common radiopaque medications which appear in X-ray
"Cheap bit"

Chloral hydrate,Cocaine,Ca.
Heavy metals.
Enteric coated tablets.
Antihistamines,Arsenic.
Phenothiazines,potassium.

Barium.
Iodide,Iron.
Tricyclic antidepressants.

Dr Ibrahim

-Don't soil scorpion sting.

Don't soil(تلوث)scorpion sting

(Don't perform the following in scorpion sting):-

Suction of the wound.
Over treat by hypnotics (over sedation).
Immersion of injured extremity in ice.
Local incision.

Dr Ibrahim

-Sites of esophageal constrictions.

Sites of esophageal constrictions are
collected in the word "Dial" at

Diaphragm (15 inches from incisor).
Inlet of the esophagus(6 inches from incisor).
Aortic arch crosses it(9 inches from incisor).
Left main bronchus crosses it (12 inches from incisor).

Importance :-

• During passage of insturments (gastroscope) along the esophagus.
• Lodging of swollen foreign bodies.

Dr Ibrahim

- Gastric Lavage.

- Gastric lavage:- also commonly called Stomach wash or Gastric suction, is the process of cleaning out the contents of the stomach. It has been used for eliminating poisons from the stomach.

- Indications:-

1. With patient has ingested a potentially life-threatening amount of a poison and the procedure can be undertaken within 60 minutes of ingestion.
2. Cleaning the stomach before an upper endoscopy in someone who has been vomiting blood.
3. Collecting stomach acid for tests.
4. Relieving pressure in someone with a blockage in the intestines.

- Contraindications :-

1. Loss of airway protective reflexes, such as in a patient with a depressed state of consciousness.
2. Ingestion of a corrosive substance such as a strong acid or alkali.
3. Ingestion of a hydrocarbon with high aspiration potential.
4. Patients who are at risk of hemorrhage or gastrointestinal perforation due to pathology, recent surgery, or other medical condition, that could be further compromised by the use of gastric lavage.

- Complications:-

• Aspiration pneumonia.
• Laryngospasm.
• Hypoxia and hypercapnia.
• Mechanical injury to the throat, esophagus, and stomach.
• Fluid and electrolyte imbalance.
• Struggling patients may be at greater risk of complications

- Technique:-

1. Gastric lavage involves the passage of a tube via the mouth or nose down into the stomach, followed by sequential administration and removal of small volumes of liquid.
2. The placement of the tube in the stomach must be confirmed either by air insufflation while listening to the stomach, by pH testing a small amount of aspirated stomach contents, or x-ray. This is to ensure the tube is not in the lungs.
3. Lavage is repeated until the returning fluid shows no further gastric contents.
4.  If the patient is unconscious or cannot protect their airway then the patient should be intubated before performing lavage.

- Finally there is video which learn you how to perform gastric lavage...

video: Nasogastric Intubation from New England Journal of Medicine..

Watch the video online.

Download - Windows Media version.

Dr Ibrahim