CPAS

Circumferential pelvic anti-shock sheeting. A. A sheet is placed under the pelvis. B. The ends are brought together anteriorly. C. Hemostats are used to secure the sheet snugly.

* A simple method for obtaining temporary pelvic stabilization when an external fixator cannot be applied is the application of a circumferential pelvic anti-shock sheet (CPAS).
* Advantages of this technique include the fact that it is inexpensive and readily available in all EDs. Special training is not required and the emergency physician can apply the sheet. Lower extremity and abdominal access is maintained after the sheet is placed.
* Caution is required in patients with lateral compression pelvic ring injuries or sacral neuroforaminal fractures. Forceful or aggressive CPAS application could worsen visceral injury or sacral nerve root injury in these instances.

SLUG BAM: Muscarinic effects of Acetylcholine

Acetylcholine acts on two vastly different classes of receptors - nicotinic receptors (with two subtypes, one at the neuromuscular junction of skeletal muscle, the other within ganglia and the CNS), and muscarinic receptors (widely distributed within both peripheral and central nervous systems).

**Muscarinic effects SLUG BAM:

• Salivation/ Secretions/ Sweating
• Lacrimation
• Urination
• Gastrointestinal upset
• Bradycardia/ Bronchoconstriction/ Bowel movement
• Abdominal cramps/ Anorexia
• Miosis

Surface anatomy of the Stomach

The cardiac orifice is opposite the 7th left costal cartilage about 2.5 cm. from the side of the sternum; it corresponds to the level of the tenth thoracic vertebra.
The pyloric orifice is on the transpyloric line about 1 cm. to the right of the middle line, or alternately 5 cm. below the 7th right sternocostal articulation; it is at the level of the first lumbar vertebra.
A curved line, convex downward and to the left, joining these points indicates the lesser curvature. In the left lateral line the fundus of the stomach reaches as high as the 5th interspace or the 6th costal cartilage, a little below the apex of the heart.

To indicate the greater curvature a curved line is drawn from the cardiac orifice to the summit of the fundus, thence downward and to the left, finally turning medialward to the pyloric orifice, but passing, on its way, through the intersection of the left lateral with the transpyloric line. The portion of the stomach which is in contact with the abdominal wall can be represented roughly by a triangular area the base of which is formed by a line drawn from the tip of the 10th left costal cartilage to the tip of the 9th right cartilage, and the sides by two lines drawn from the end of the 8th left costal cartilage to the ends of the base line.

Note That: This measurements given refer to a moderately filled stomach with the body in the supine position !!!  Why we say that.........
As The shape of the stomach is constantly undergoing alteration; it is affected by the particular phase of the process of gastric digestion, by the state of the surrounding viscera, and by the amount and character of its contents. Its position also varies with that of the body.

With the patient in the erect posture.

With the patient lying down.

A case of Scabies

A35-year-old woman presents with a pruritic rash that has been present over the last few weeks. The area affected is in the webs of the fingers, and symptoms are reported to be worse at night. Topical over-the-counter steroids have not been beneficial. The likely diagnosis is:

• A)poison ivy
• B)dyshidrotic eczema
• C)scabies
• D)tinea corporis
• E)psoriasis

The answer is ( C ). (Scabies) 
The condition of scabies is associated with intense pruritus that is noted predominantly at night. The lesions are brownish in color and often form irregular burrow lines that may be marked with scaling at one end and a vesicle at the other end. The lesions are typically found in intertriginous areas and warm, protected areas such as the finger webs, inframammary areas, and axilla. The mite Sarcoptes scabei is responsible. Scrapings of the lesion are treated with 10% potassium hydroxide solution and studied under light microscopy. The mite is often identified. Treatment consists of permethrin cream 5% applied from head to toes and left in place for 12 hours before being washed off. Lindane can also be used as an alternative, but not in infants or in pregnant women.

Critical Care (Civetta) - 4th Edition

The leading critical care textbook since 1988, Civetta, Taylor and Kirby’s Critical Care is now in its Fourth Edition, with a new editorial team, over thirty new chapters, and completely updated information. The book addresses every problem encountered in the intensive care unit and covers surgicalcritical care more thoroughly than any other text. Each chapter begins with immediate concerns and proceeds to broader-based discussions of relevant pathophysiologic and clinical issues.

This edition has new sections on shock states; pharmacology, nutrition, toxicology and the environment; and disaster management. New chapters include bedside ultrasound, point of care testing, neurogenic shock, anaphylactic shock, surgical infections, and acute coronary syndrome.

PART 1 - PART 2

Diagram for Liver relations

Amniotic band sequence

Amniotic band sequence is a disruption sequence with a broad spectrum of clinical manifestations (The frequency is comprised between 1/1200 to 1/15 000 births) it is ranging from partial amputations to major craniofacial and limb-body wall defects.

This amniotic bands are the result of adhesions between the amnion and embryonic or fetal parts. Their . Amniotic bands cause masive malformations with limb amputations, sever abdominal or cranial wall defects. Two different theories have been proposed: constrictive amniotic bands secondary to early amnion rupture, and vascular disruption events.

The anomalies are characteristically asymmetrical and usually prediposed by:
- familial predisposition
- amniocentesis

Associations:
- short umbilical cord
- early amnion rupture-oligohydramnios disruption (EAROD)
- amniotic deformity-adhesion mutilation (ADAM)

EX: limb anomalies

•  intrauterine amputations
•  limb constriction rings
•  pseudosyndactyly
•  club feet
•  abnormal dermatoglyphs

This term infant was born with foot and finger anomalies resulting from amniotic bands.