Algorithm for Emergency Management of Complicated STEMI

STEMI = ST-elevation myocardial; IV = intravenous; SL = sublingual; SBP = systolic blood pressure; BP = blood pressure; ACE = angiotensin converting enzyme

Surgery Resident vs Medical Student

Blueprints Surgery (Blueprints series):5th edition 2009

Part of the Blueprints series, Blueprints Surgery provides a concise review of what students need to know in their surgery rotations or the Boards. Each chapter is brief and includes pedagogical features such as bolded key words, tables, figures, and key points boxes. This edition has been thoroughly updated and significantly expanded, with more detail and depth of coverage, additional tables and figures, and case studies. A question-and-answer section at the end of the book includes 100 board-format questions with complete rationales for each answer choice. A companion website includes a question bank containing an additional 50 questions and fully searchable text.

PART 1 - PART 2

Cardiac Pacemaker

It is represents External Energy Sources Used To Stimulate The Heart Primarily In Patients With Symptomatic Heart Blocks And Bradyarrhythmias.

 Indication :

* Selection Of The Appropriate Pacemaker And Pacing Mode Depends On The Clinical Condition And The Type Of Bradyarrhythmia Being Treated
* Temporary Pacing :

• For Symptomatic Bradicardia Due To Temporary Condition, Or As A Bridge To Permanent Pacer Placement

* Permanent Pacing : 

• Symptomatic Bradycardia Due To : SA Nodal Dysfunction, Irreversible 2nd Or 3rd Degree AV Block
• Recurrent Syncope Due To Carotid Sinus Hypersensitivity

* Physiologic Pacemakers (Rate Modulating) Are Essential When :

• Chronotropic Incompetence Is Present
• An Increase In Heart Rate Is Required To Enchance Physiologic Performance

Happy Holidays from Stanford Hospital & Clinics 2010

Stanford Hospital & Clinics asked its employees what they are thankful for this holiday season, here are their answers.

Stanford Hospital & Clinics wishes everyone a very happy hoiday season and a happy New Year!

Ramsay Hunt Syndrome(clinical)

CAUSES:
Classic Ramsay Hunt syndrome is ascribed to infection of the geniculate ganglion by herpesvirus 3 (varicella-zoster virus [VZV]).



HISTORY:
*Patients usually present with paroxysmal pain deep within the ear. The pain often radiates outward into the pinna of the ear and may be associated with a more constant, diffuse, and dull background pain.

*The onset of pain usually precedes the rash by several hours and even days.

*Classic Ramsay Hunt syndrome can be associated with the following:
-Vesicular rash of the ear or mouth (as many as 83% of cases),The rash might precede the onset of facial paresis/palsy.
-Ipsilateral lower motor neuron facial paresis/palsy (CN VII)
-Vertigo and ipsilateral hearing loss (CN VII)
-Tinnitus,Otalgia,Headaches,DysarthriaGait,ataxia.
-Fever,Cervical adenopathy.

*Facial weakness usually reaches maximum severity by one week after the onset of symptoms.

*Other cranial neuropathies might be present and may involve cranial nerves (CNs) VIII, IX, X, V, and VI.

*Ipsilateral hearing loss has been reported in as many as 50% of cases.

*Blisters of the skin of the ear canal, auricle, or both may become secondarily infected, causing cellulitis.


EXAMINATION:

.The primary physical findings in classic Ramsay Hunt syndrome include peripheral facial nerve paresis with associated rash or herpetic blisters in the distribution of the nervus intermedius.
.The location of the accompanying rash varies from patient to patient, as does the area innervated by the nervus intermedius. It may include the following:
1.Anterior two thirds of the tongue
2.Soft palate
3.External auditory canal
4.Pinna
.The patient may have associated ipsilateral hearing loss and balance problems.
.A thorough physical examination must be performed, including neuro-otologic and audiometric assessment.

Indirect IA (Inferior Alveolar) nerve block on a model

University of The Pacific Arthur A. Dugoni School of Dentistry present a video illustrating the technique of Inferior Alveolar Nerve Block on a model by Dr. Anders Nattestad, Professor and Director, Department of Oral and Maxillofacial Surgery.