Urologic Surgical Procedures
Education, Medical, Undergraduate
Bruits, ophthalmodynamometry and rectilinear scanning on transient ischemic attacks. (1/162)One hundred seventeen patients with clinical signs and symptoms of transient ischemic attacks (TIAs) were evaluated. All underwent clinical evaluation for bruit, ophthalmodynamometry, rapid sequence scintiphotography with rectilinear scanning and four-vessel cerebral angiography. The results of these tests were compared for reliability in predicting location of lesions causing transient ischemic attacks. Angiography remains the most accurate procedure in evaluating extracranial vascular lesions. When determination of bruits, ophthalmodynamometry and brain scanning are done together, accuracy is greater than when any one of the procedures is done alone. (+info)
Comparison of four methods for assessing airway sealing pressure with the laryngeal mask airway in adult patients. (2/162)We have compared four tests for assessing airway sealing pressure with the laryngeal mask airway (LMA) to test the hypothesis that airway sealing pressure and inter-observer reliability differ between tests. We studied 80 paralysed, anaesthetized adult patients. Four different airway sealing pressure tests were performed in random order on each patient by two observers blinded to each other's measurements: test 1 involved detection of an audible noise; test 2 was detection of end-tidal carbon dioxide in the oral cavity; test 3 was observation of the aneroid manometer dial as the pressure increased to note the airway pressure at which the dial reached stability; and test 4 was detection of an audible noise by neck auscultation. Mean airway sealing pressure ranged from 19.5 to 21.3 cm H2O and intra-class correlation coefficient was 0.95-0.99. Inter-observer reliability of all tests was classed as excellent. The manometric stability test had a higher mean airway sealing pressure (P < 0.0001) and better inter-observer reliability (P < 0.0001) compared with the three other tests. We conclude that for clinical purposes all four tests are excellent, but that the manometric stability test may be more appropriate for researchers comparing airway sealing pressures. (+info)
Effect of positioning on recorded lung sound intensities in subjects without pulmonary dysfunction. (3/162)BACKGROUND AND PURPOSE: Physical therapists often use positioning to assist in the reexpansion of collapsed lung segments. An increase in lung sound intensity on auscultation is considered indicative of lung expansion. This study was designed to examine whether clinical interpretation of auscultatory findings is warranted. SUBJECTS: The subjects (5 male, 6 female) were young physical therapist students without pulmonary dysfunction (mean age=20.4 years, mean height=166.3 cm, mean weight=57.5 kg). Subjects with lung disease were excluded because pulmonary pathology is difficult to standardize. METHODS: Lung sounds electronically recorded over the posterior chest wall of subjects in sitting and side-lying positions were compared. Measures included peak intensity, frequency at maximum power, and median frequency. RESULTS: In the sitting position, inspiratory sounds recorded over the left posterior chest wall were louder than those recorded on the right side. In the side-lying positions, the sound intensity recorded from the dependent chest wall was louder than that recorded from the nondependent chest wall. In side-lying positions, the upper hemithorax is "nondependent," and the side in contact with the bed is "dependent." Sound intensities recorded over both posterior chest walls in the sitting position were louder than those recorded over the same lung area in the nondependent side-lying position. There was no difference in the sound intensity recorded between the sitting and dependent side-lying postures. CONCLUSION AND DISCUSSION: When comparative auscultation of the chest wall is used by physical therapists to assess the adequacy of pulmonary ventilation, patient posture and regional differences in breath sound intensity can influence clinical interpretation. (+info)
Heart murmurs in pediatric patients: when do you refer? (4/162)Many normal children have heart murmurs, but most children do not have heart disease. An appropriate history and a properly conducted physical examination can identify children at increased risk for significant heart disease. Pathologic causes of systolic murmurs include atrial and ventricular septal defects, pulmonary or aortic outflow tract abnormalities, and patent ductus arteriosus. An atrial septal defect is often confused with a functional murmur, but the conditions can usually be differentiated based on specific physical findings. Characteristics of pathologic murmurs include a sound level of grade 3 or louder, a diastolic murmur or an increase in intensity when the patient is standing. Most children with any of these findings should be referred to a pediatric cardiologist. (+info)
Methacholine challenge in preschool children: methacholine-induced wheeze versus transcutaneous oximetry. (5/162)Tracheal/chest auscultation for wheeze and transcutaneous oximetry have both been suggested as measures of outcome in bronchial provocation tests in young children. This study aimed to compare the sensitivity and safety of these two techniques as end-points for methacholine challenge in children aged <4 yrs. Seventy-two methacholine challenges were performed in 39 children aged <4 yrs with recurrent wheeze. Arterial oxygen saturation (Sa,O2) and transcutaneous oxygen pressure tcPO2 continuously, and the test was terminated when wheeze was heard or at Sa,O2 <91%. tcPO2 was not used as an end-point. Wheeze or desaturation occurred at < or =8 mg x mL(-1) methacholine in every test. One child had transient clinical cyanosis, but no other ill-effects were seen. Fifty-six tests (78%) were terminated for wheeze, seven (10%) for fall in Sa,O2 and nine (12%) showed simultaneous responses in both parameters. Twenty-eight tests (39%) contained a fall in tcPO2 >3 kPa but six of these also showed a significant rise. Fifty-three tests (75%) contained a fall in tcPO2 >15%, but 20 of these also showed a significant rise. Tracheal/chest auscultation with Sa,O2 monitoring is a sensitive and relatively safe end-point for bronchial challenges in preschool children. The erratic pattern of transcutaneous oxygen pressure response in some children casts doubt on its reliability as a proxy measure of bronchial obstruction. (+info)
Acoustic monitoring of intraoperative neuromuscular block. (6/162)Standard methods for accurate intraoperative measurement of neuromuscular block are either expensive or inconvenient and are not used widely. We have evaluated a new method of monitoring neuromuscular block using a low-frequency microphone. The method is based on the phenomenon of low-frequency sound emission by contracting skeletal muscle. Acoustic monitoring (MIC) with an air-coupled microphone was used to evaluate intraoperative neuromuscular block in 25 anaesthetized patients. The MIC recorded the response of the adductor pollicis muscle to supramaximal electrical stimulation of the ulnar nerve with train-of-four stimuli. The ratios of the first response (TI) to control (TC) were used for evaluation. Data obtained from the MIC were compared with simultaneous recordings, from the same hand, of mechanomyography (FDT), electromyography (EMG) and accelerography (ACC). Throughout the operative procedure, TI/TC ratios of the acoustic method correlated with the three reference devices: FDT, 12 patients, 262 data sets, r = 0.86, bias (%MIC-%FDT) = mean -5.3 (SD 19.6)%; EMG, 18 patients, 490 data sets, r = 0.85, bias (%MIC-%EMG) = -0.39 (20.29)%; and ACC, 13 patients, 328 data sets, r = 0.91, bias (%MIC-%ACC) = -3.0 (15.6)%. We conclude that monitoring intraoperative neuromuscular block by a microphone which transduces low-frequency muscle sounds is clinically feasible. (+info)
A new double cuff sphygmotonometer for accurate blood pressure measurement. (7/162)Accurate measurement of blood pressure (BP) is essential in the diagnosis and treatment of hypertension, but neither auscultatory nor oscillometric methods measure intra-arterial BP accurately in all circumstances. Algorithms for automatic BP-measuring devices differ from manufacturer to manufacturer, and no clear authorized algorithm criteria have yet been established. We have devised a double-cuff sphygmotonometer to measure BP on the basis of clear algorithms, and investigated the accuracy of this new method by comparing it with the photo-oscillometric method, which is the most accurate method for non-invasive measurement of intra-arterial BP. In the new method, a small cuff (3x6 cm) replaces the photo-sensor in the brachial cuff (13x24 cm) of the photo-oscillometric device, and BP is determined by means of the oscillation within the small cuff. The comparison based on procedures of AAMI-protocol was performed in 136 hypertensive patients and 54 normotensive subjects. The difference in systolic BP between the photooscillometric and double-cuff methods was -2.26+/-2.31 mmHg (89% under 5 mmHg), and the corresponding difference in diastolic BP was 1.9+/-2.50 mmHg (94% under 5 mmHg). In conclusion, we have devised a new double-cuff method which improves on the photo-oscillometric method, and although it seems to be less accurate than the photo-oscillometric method, the clarity of its algorithm makes it superior to the conventional oscillometric and auscultatory methods employing only one cuff. (+info)
The clinical evaluation of the Respi-check mask: a new oxygen mask incorporating a breathing indicator. (8/162)Study objective-To investigate the correlation between the Respi-check sensor and simultaneous chest auscultation in determining the respiratory rates in adults. METHODS: Random visits to a local accident and emergency (A&E) department were made and all patients wearing oxygen masks were recruited into the study. The new sensor was attached to the outside of the mask. One researcher auscultated the chest to count breaths, the other counted the sensor activity. Each was blinded to the activities of the other. Breaths were counted by each researcher simultaneously and independently over one minute. A total of 40 patients were recruited into the study. A difference of more than two breaths/min compared with chest auscultation was deemed as a sensor failure. RESULTS: The respiratory rates of 40 patients were measured. There were 28 men, 12 women. Twenty six patients were wearing an Intersurgical high concentration (flow 12l/min) mask, 14 were wearing an aerosol mask with variable venturi (flow 3-12l/min) by Medicaid. Over one minute rates determined by the two methods were the same in 28 cases (70%). It was accurate to within one breath in 37 cases (93%) and to within two breaths in 39 (98%) cases and in one case (2.5%) the sensor failed. The mean difference (mean of the differences between rates obtained from auscultation and the new sensor) was -0.1282 breaths/min, with limits of agreement (d (2SD) between -1.414 to 1.157 breaths/min. CONCLUSION: The Respi-check sensor provides an accurate method of estimating the respiratory rate in adult patients attending the A&E department. (+info)
There are two main types of heart murmurs:
1. Innocent murmurs: These are benign murmurs that are not caused by any underlying heart condition. They are often heard in healthy children and may disappear as the child grows.
2. Abnormal murmurs: These are murmurs that are caused by an underlying heart condition, such as a congenital heart defect or heart valve disease. These murmurs can be a sign of a serious heart problem and may require further evaluation and treatment.
Heart murmurs can be diagnosed by a pediatrician or cardiologist using a stethoscope to listen to the heart sounds. Additional tests, such as an echocardiogram or electrocardiogram (ECG), may be ordered to confirm the diagnosis and determine the cause of the murmur.
Treatment for heart murmurs depends on the underlying cause of the condition. In some cases, no treatment may be needed, while in other cases, medication or surgery may be required. It is important for individuals with heart murmurs to receive regular follow-up care from a pediatrician or cardiologist to monitor the condition and address any complications that may arise.
In summary, heart murmurs are abnormal sounds heard during a heartbeat that can be a sign of an underlying heart condition. They can be diagnosed by a pediatrician or cardiologist using a stethoscope and additional tests, and treatment depends on the underlying cause of the condition. Regular follow-up care is important to monitor the condition and address any complications that may arise.
Respiratory sounds can help healthcare providers diagnose and manage respiratory conditions, such as asthma, chronic obstructive pulmonary disease (COPD), and pneumonia. By listening to the sounds of a patient's breathing, healthcare providers can identify abnormalities in lung function, airway obstruction, or inflammation.
Types of Respiratory Sounds:
1. Vesicular Sounds:
a. Inspiratory wheeze: A high-pitched whistling sound heard during inspiration, usually indicative of bronchial asthma or COPD.
b. Expiratory wheeze: A low-pitched whistling sound heard during expiration, typically seen in patients with chronic bronchitis or emphysema.
c. Decreased vocal fremitus: A decrease in the normal vibratory sounds heard over the lung fields during breathing, which can indicate fluid or consolidation in the lungs.
2. Adventitious Sounds:
a. Crackles (rales): High-pitched, bubbly sounds heard during inspiration and expiration, indicating fluid or air in the alveoli.
b. Rhonchi: Low-pitched, harsh sounds heard during inspiration and expiration, often indicative of bronchitis, pneumonia, or COPD.
c. Stridors: High-pitched, squeaky sounds heard during breathing, commonly seen in patients with inflammatory conditions such as pneumonia or tuberculosis.
It's important to note that the interpretation of lung sounds requires a thorough understanding of respiratory physiology and pathophysiology, as well as clinical experience and expertise. A healthcare professional, such as a nurse or respiratory therapist, should always be consulted for an accurate diagnosis and treatment plan.
Gastric dilatation can occur for various reasons, including:
1. Eating too quickly or consuming large amounts of food in a short period of time.
2. Swallowing air, which can happen when eating or drinking too quickly or sucking on hard candies.
3. Eating certain types of foods that are difficult to digest, such as beans or cabbage.
4. Medical conditions such as irritable bowel syndrome (IBS), gastroparesis, or hiatal hernia.
5. Inflammation or infection of the stomach lining, such as gastritis.
Symptoms of gastric dilatation may include:
* Bloating and discomfort in the abdomen
* Pain or cramping in the abdomen
* Feeling nauseous or vomiting
* Gas and belching
* Diarrhea or constipation
Treatment for gastric dilatation usually involves making lifestyle changes, such as eating smaller, more frequent meals, avoiding foods that trigger symptoms, and reducing stress. In some cases, medications may be prescribed to help manage symptoms. If the condition is caused by an underlying medical condition, treating the underlying condition can help resolve the gastric dilatation.
In severe cases of gastric dilatation, surgical intervention may be necessary. This may involve laparoscopic or open surgery to repair any anatomical abnormalities or to remove any blockages in the digestive tract.
It's important to note that gastric dilatation can lead to more serious complications, such as gastric rupture or perforation, which can be life-threatening. If you experience severe abdominal pain, fever, or vomiting blood, seek medical attention immediately.
Preventing gastric dilatation involves maintaining a healthy diet and lifestyle, managing stress, and avoiding trigger foods. It's also important to drink plenty of water and exercise regularly to promote digestive health. If you experience any symptoms of gastric dilatation, it's important to seek medical attention promptly to prevent complications.
There are several possible causes of airway obstruction, including:
1. Asthma: Inflammation of the airways can cause them to narrow and become obstructed.
2. Chronic obstructive pulmonary disease (COPD): This is a progressive condition that damages the lungs and can lead to airway obstruction.
3. Bronchitis: Inflammation of the bronchial tubes (the airways that lead to the lungs) can cause them to narrow and become obstructed.
4. Pneumonia: Infection of the lungs can cause inflammation and narrowing of the airways.
5. Tumors: Cancerous tumors in the chest or throat can grow and block the airways.
6. Foreign objects: Objects such as food or toys can become lodged in the airways and cause obstruction.
7. Anaphylaxis: A severe allergic reaction can cause swelling of the airways and obstruct breathing.
8. Other conditions such as sleep apnea, cystic fibrosis, and vocal cord paralysis can also cause airway obstruction.
Symptoms of airway obstruction may include:
1. Difficulty breathing
2. Wheezing or stridor (a high-pitched sound when breathing in)
3. Chest tightness or pain
4. Coughing up mucus or phlegm
5. Shortness of breath
6. Blue lips or fingernail beds (in severe cases)
Treatment of airway obstruction depends on the underlying cause and may include medications such as bronchodilators, inhalers, and steroids, as well as surgery to remove blockages or repair damaged tissue. In severe cases, a tracheostomy (a tube inserted into the windpipe to help with breathing) may be necessary.
There are several types of asbestos, including chrysotile, amianthus, and crocidolite, each of which has different levels of toxicity. Prolonged exposure to any type of asbestos can cause asbestosis, but some types are more dangerous than others.
Symptoms of asbestosis may not appear until many years after exposure to asbestos, and they can vary in severity. Common symptoms include:
* Shortness of breath
* Permanent lung damage
* Scarring of the lungs
* Decreased lung function
Treatment for asbestosis usually involves managing symptoms and improving lung function. This can include medications to relieve coughing and shortness of breath, pulmonary rehabilitation to improve lung function, and oxygen therapy to help increase oxygen levels in the blood. In severe cases, lung transplantation may be necessary.
Prevention is key in avoiding asbestosis. If you suspect that you have been exposed to asbestos, it is important to speak with a healthcare professional as soon as possible. Proper safety measures and precautions can help minimize the risk of developing asbestosis.
There are many different types of heart diseases, including:
1. Coronary artery disease: The buildup of plaque in the coronary arteries, which supply blood to the heart muscle, leading to chest pain or a heart attack.
2. Heart failure: When the heart is unable to pump enough blood to meet the body's needs, leading to fatigue, shortness of breath, and swelling in the legs.
3. Arrhythmias: Abnormal heart rhythms, such as atrial fibrillation or ventricular tachycardia, which can cause palpitations, dizziness, and shortness of breath.
4. Heart valve disease: Problems with the heart valves, which can lead to blood leaking back into the chambers or not being pumped effectively.
5. Cardiomyopathy: Disease of the heart muscle, which can lead to weakened heart function and heart failure.
6. Heart murmurs: Abnormal sounds heard during a heartbeat, which can be caused by defects in the heart valves or abnormal blood flow.
7. Congenital heart disease: Heart defects present at birth, such as holes in the heart or abnormal blood vessels.
8. Myocardial infarction (heart attack): Damage to the heart muscle due to a lack of oxygen, often caused by a blockage in a coronary artery.
9. Cardiac tamponade: Fluid accumulation around the heart, which can cause compression of the heart and lead to cardiac arrest.
10. Endocarditis: Infection of the inner lining of the heart, which can cause fever, fatigue, and heart valve damage.
Heart diseases can be diagnosed through various tests such as electrocardiogram (ECG), echocardiogram, stress test, and blood tests. Treatment options depend on the specific condition and may include lifestyle changes, medication, surgery, or a combination of these.
Triangle of auscultation
Richard Wainright Duke Turner
Swimming-induced pulmonary edema
Carl Jakob Adolf Christian Gerhardt
Austin Flint I
Fourth heart sound
Third heart sound
Emergency medical personnel in the United Kingdom
Congenital heart defect
Atrioventricular septal defect
Mark E. Silverman
Ventricular septal defect
Auscultation: MedlinePlus Medical Encyclopedia
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Internet Scientific Publications
- Digital devices for teaching cardiac auscultation - a randomized pilot study. (bvsalud.org)
- Competent cardiac auscultation is a declining skill. (bvsalud.org)
- Digital stethoscopes and hand -held echo may be useful devices for teaching cardiac auscultation . (bvsalud.org)
- This pilot study provides a novel study design, a heart murmur grading system, and data that will help develop definitive studies to assess new teaching techniques for cardiac auscultation using digital technology . (bvsalud.org)
- Cardiac auscultation reveals regular rhythm with no murmurs or gallop. (hawaii.edu)
- a sound of less than usual intensity in percussion or auscultation. (dictionary.com)
- Auscultation is usually done using a tool called a stethoscope. (medlineplus.gov)
- The student must palpate to identify the correct auscultation sites and will hear different heart, bowel, and lung sounds as the SmartScope is moved from site to site. (cpr-savers.com)
- Students ' scores were compared to a ' gold standard' derived from a consensus of auscultation findings of three cardiologists . (bvsalud.org)
- Providers also use auscultation to listen to the heart sounds of unborn infants. (medlineplus.gov)
- constantly on the go, which is a crucial feature for ensuring students spend adequate time practicing their auscultation skills. (lifesim.ae)
- Includes Infant Auscultation Trainer, SmartScope remote, and hard carry case. (cpr-savers.com)
- students will have access to everything they need to master their auscultation skills. (lifesim.ae)
- Cardiac auscultation is a critical part of the clinical examination. (medscape.com)
- In this review we discuss the conventional approach to teaching and using the skill of cardiac auscultation. (medscape.com)
- Cite this: Cardiac Auscultation: The Past, Present and Future - Medscape - Nov 01, 2010. (medscape.com)
- As with most clinical procedures, in performing cardiac auscultation in the elderly patient, preparation, orientation, and self-discipline are key. (medscape.com)
- Cardiac Auscultation in the Older Adult - Medscape - Jan 18, 2012. (medscape.com)
- Providers also use auscultation to listen to the heart sounds of unborn infants. (medlineplus.gov)
- Auscultation is listening to the sounds of the body during a physical examination . (medlineplus.gov)