Learn Important Medical Procedures by using Procedures Consult apps of Epocrates

Epocrates presents Procedures Consult apps for internal and family medicine. These intuitive and thorough apps will help you with the most common medical procedures. Access about a hundred detailed procedures videos, including pre-and post-procedure steps.

Internal Medicine - General
25 common internal medicine procedures, including:
• Defibrillation
• Local Anesthesia
• Lumbar Puncture
• Thoracentesis
• Tick Removal
• Transcutaneous Pacing



Internal Medicine - Musculoskeletal
22 common musculoskeletal procedures common to internal medicine, including:
• Arthrocentesis: Knee • Long Arm Splint
• Coaptation Splint • Sugar Tong Splint
• Dislocation Reduction of the PIP and DIP Joints • Dislocation Reduction of the Hip Joint

Family Medicine - General
27 common family medicine procedures, including:
• Anoscopy
• Excisional Biopsy
• Lumbar Puncture
• Shoulder Relocation
• Trigger Point Injection
• Wart Treatment

Family Medicine - Women's Health & Obstetrics
24 procedures common to women's health in family medicine, including:
• Breast Cyst Aspiration • Dilation and Curettage
• Cervical Polypectomy • Forceps Delivery
• Colposcopy • Word Catheter Placement


Procedures Consult apps, Breast Cyst Aspiration, Cervical Polypectomy, Colposcopy, Lumbar Puncture, Arthrocentesis, Defibrillation, Epocrates

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Yes, Cell Phone Radiation shields are Scams

Here's what the FTC has to say about cell phone radiation shields:

Listen Up: Tips to Help Avoid Cell Phone Radiation Scams

Whether you call them cell phones, smart phones or mobile devices, it seems like everyone has one. According to the wireless telecommunications industry, the U.S. now has an estimated 300 million mobile subscribers, compared to 110 million subscribers a decade ago. The increase in cell phone use has generated concern about possible health risks related to radiofrequency electromagnetic fields from this technology, and a market for shields as possible protection against the radio waves the phones emit. The Federal Trade Commission (FTC), the nation's consumer protection agency, has some practical tips to help you avoid scams and limit your exposure to electromagnetic emissions from your cell phone.

While health studies about any relationship between the emissions from cell phones and health problems are ongoing, recent reports from the World Health Organization will no doubt convince scam artists that there's a fast buck to be made. Scam artists follow the headlines to promote products that play off the news – and prey on concerned people.

If you're looking for ways to limit your exposure to the electromagnetic emissions from your cell phone, know that, according to the FTC, there is no scientific proof that so-called shields significantly reduce exposure from these electromagnetic emissions. In fact, products that block only the earpiece – or another small portion of the phone – are totally ineffective because the entire phone emits electromagnetic waves. What's more, these shields may interfere with the phone's signal, cause it to draw even more power to communicate with the base station, and possibly emit more radiation.

To limit your exposure to cell phone electromagnetic emissions, the FTC suggests that you:

• Increase the distance between your phone and your head by using a hands-free device, like an earpiece that is wired to the phone, or using the speakerphone feature.
• Consider texting more and limiting your cell phone use to short conversations.
• Wait for a good signal. When you have a weak signal, your phone works harder, emitting more radiation. Phones also give off more radiation when transmitting than when receiving, so tilt the phone away from your head when you're talking, and bring it back to your ear when you're listening.

When you're in the market for a new phone, research a phone's specific absorption rate (SAR) before you buy. Measured in watts per kilogram of tissue, the SAR reveals how much radiation the body absorbs while using the mobile device. Different phones emit different amounts of radiation. In the U.S., a phone's SAR can't exceed 1.6 watts per kilogram. The Federal Communications Commission (FCC) has SAR information for cell phones produced and marketed within the last two years. You can access this information using the phone's FCC ID number, usually located on the case of the phone, and the FCC's ID search form at www.fcc.gov/oet/ea/fccid. The Environmental Working Group also maintains a listing at www.ewg.org/cellphone-radiation

Key Words:
electromagnetic waves, hands-free device, Cell Phone Radiation Scams, smart phones, mobile devices, radiofrequency

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Common Causes and Symptoms of Burning Headache

Many people suffer from this common nuisance called burning headache every day, in some cases which can even last for days. Burning headache is not a medically recognized term if you were to look around in medical journals and clinical documents, but it's pretty much commonly used. There are many different causes of burning headache, and different people have different parts of the head which aches. Besides, there are also many different causes of this headache, some of which we will be looking at today.

Different Parts of the Head:
In many instances, burning headache is related to sinusitis. In that case, the pain is usually on the frontal part of the head, on the forehead, upper cheeks, and sometimes can even travel around the whole face. In other cases, this burning headache can be caused by fever. In this, the pain is usually on both sides of the forehead, which are the weakest points of sensitivity in our head.

Causes:
As we have already known, the common reasons for burning headache would be fever, flu, and sinusitis. In these cases, the pain is constant, and can be stinging and tingling, and not to mention burning. It can originate from any side of the head, but usually after a while it will travel to other areas as well.

Some people tend to get thrusts of extreme pains. Although medically there is no proof as to what causes this sudden uprising in the burning headache symptoms, it is believed to be caused by pulsating nerves due to tension.

Burning headache can also be caused by certain other reasons besides the above listed. These are more serious cases such as tumors or growth in the head. In such cases, the pain is not constant like the ones listed above, but comes on and off. The pain is usually violent, far stronger than the ones you get for fever, and not to forget; it pulsates often.

It is also believed that toxins and chemicals can also cause acute or burning headache. This is pretty common to many people, especially those who are not so favorable of newly painted houses, chemical labs, and so on. On top of these, even certain edible toxins and foods can cause burning headache, such as alcohol, caffeine, and so on.

Alcohol and caffeine especially, are believed to be causes of many serious headaches that can cause the whole head to ache severely, with the nerves being extremely tensed.

Key Words:
burning headache, medical journals, causes of burning headache, sinusitis, fever, burning headache symptoms, tumors

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How to Perform Paracentesis

• Indications:
  • Diagnostic studies
  • Ascites
  • Spontaneous bacterial peritonitis
  • Therapeutic purposes
  • Relief of respiratory compromise
  • Relief of abdominal pain and discomfort
• Contraindications:
  • Coagulopathy (PT or PTT > 1.3)
  • Thrombocytopenia (plt < 60,000)
  • Bowel obstruction
  • Pregnancy
  • Infected skin or soft tissue at entry site
• Anesthesia:
  1% lidocaine
• Equipment:
  • Sterile prep solution
  • Sterile towels
  • Sterile gloves
  • 5-ml syringes, 20-ml syringes, 25-gauge and 22-gauge needles
  • 3-way stopcock, IV tubing
  • IV catheter (diagnostic: 20-gauge, therapeutic: 18-gauge) or long 16-gauge (CVP-type) catheter with 0.035-cm J wire
  • 500- to 1000-ml vacuum bottles and IV drip set (for therapeutic paracentesis)
• Positioning:
  Supine
  • Preferred sites of entry to prevent bleeding from epigastric vessels (see Figure 5.7)
  • Either lower quadrant (anterior iliac spine)
  • Lateral to the rectus muscle and at the level of or just below the umbilicus
  • Infraumbilically in the midline
  
  
• • The entry site should not be the site of a prior incision and should be free of gross contamination and infection.
  • The entry sites are percussed to confirm the presence of fluid and the absence of underlying bowel.
  • The patient should empty his or her bladder prior to the procedure, and/or a Foley catheter should be placed to decrease the possibility of puncturing the bladder.
• Technique Diagnostic Sampling:
  • Prepare site with sterile prep solution and drape with sterile towels.
  • Use 25-gauge needle to anesthetize skin and 22-gauge needle to anesthetize abdominal wall to peritoneum.
  • Introduce IV catheter into the abdominal cavity, aspirating as it is advanced. The needle should traverse the abdominal wall at an oblique angle to prevent persistent leak of ascites from the puncture site (see Figure 5.8).
  • When free flow of fluid occurs, the catheter should be advanced over the needle and the needle removed.
  • Draw 20–30 ml of fluid into a sterile syringe for diagnostic studies and culture.

• Technique Therapeutic Drainage:
  • Prepare site with sterile prep solution and drape with sterile towels.
  • Use 25-gauge needle to anesthetize skin and 22-gauge needle to anesthetize abdominal wall to peritoneum.
  • Introduce IV catheter into the abdominal cavity, aspirating as it is advanced. The needle should traverse the abdominal wall at an oblique angle to prevent persistent leak of ascites from the puncture site.
  • When free flow of fluid occurs, the catheter should be advanced over the needle and the needle removed. Alternatively, a CVP-type catheter with extra side holes may be placed over a guide wire using the Seldinger technique.
  • After insertion of the needle and aspiration of fluid, a J-tip guide wire is placed through the needle into the peritoneal space. The needle is removed, leaving the wire in place.
  • A stiff plastic dilator is used to dilate the tract by placing it over the wire and into the abdomen. A #11-blade scalpel can be used to make a tiny nick at the entry site as well.
  • The dilator is removed, the catheter is placed over the wire and into the abdomen, and the wire is removed.
  • Draw 20–30 ml of fluid into a sterile syringe for diagnostic studies and culture.
  • IV tubing is hooked to the catheter and to a vacuum bottle to remove a large volume of fluid.
  • Should the catheter become occluded, careful manipulation of the catheter to re-establish flow may be undertaken. Alternatively, asking the patient to turn on his or her side and again onto his or her back may also help re-establish flow. However, the needle or guide wire should not be reintroduced because of the risk of bowel injury. If less than an adequate volume is withdrawn, the catheter should be removed and replaced, possibly at another entry site.
• Complications and Management:
  • Hypotension
    • Can occur during or after procedure due to rapid mobilization of fluid from intravascular space or due to vasovagal response.
    • IV hydration can prevent and correct the hypotension in most cases.
    • 5% albumin solution or other colloid-based fluid is often used for this purpose.

• Bowel perforation
  • Rarely recognized at time of procedure
  • Can lead to infected ascites, peritonitis, and sepsis
• Hemorrhage
  • Rare, but can be caused by injury to mesentery or injury to inferior epigastric vessels.
  • Usually self-limited. Avoided by entering abdomen lateral to rectus and by correcting coagulopathy.
  • Hemodynamic instability requires laparotomy.
• Persistent ascites leak
  • Usually will seal in <2 weeks. Can result in peritonitis.
  • Skin entry site may be sutured to minimize leak.
• Bladder perforation
  • Avoided by inserting Foley catheter prior to procedure.
  • May require a period of bladder catheterization until sealed.
  • Obtain urology consult.

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Mysterious Medical syndrome

1. Werewolf Syndrome or Hypertrichosis
2. Blashko’s Line Skin Disorder
3. Albino Syndrome
4. Proteus Syndrome
5. Ondine’s Curse
6. RAS Syndrome
7. Mobius Syndrome
8. Mermaid Syndrome
9. Blue Skin Disorder
10. Progeria Syndrome

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RMC Ophthalmology (Eye) Send Up Paper 2010

Rawalpindi Medical College Ophthalmology (Eye) Sendup Paper 2010.

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How to Reduce Rectal Prolapse

• Indications:
  • Prolapse of rectum (full-thickness)
  • Mucosal prolapse of rectum (mucosa only)
• Contraindications:
  • Infarction or gangrene of prolapsed segment
  • Severe tenderness of prolapsed segment
  • Extreme edema of prolapsed segment
• Anesthesia:
  None

• Equipment:
  • Gloves
  • Water-soluble lubricant
• Positioning:
  Decubitus or dorsal lithotomy
• Technique:
  • Don gloves and apply a liberal amount of water-soluble lubricant to the prolapsed segment.
  • The concept is to apply steady, circumferential pressure on the prolapsed segment (to decrease edema) while simultaneously trying to reduce it. This is done by placing as many fingers of both hands as possible, oriented parallel to its longitudinal axis, around the segment and compressing it from all sides.
  • Apply pressure firmly and steadily, with more pressure applied at the tip than at the base.
  • Progress is typically slow and almost imperceptible. Be patient and squeeze for one to several minutes at a time, using plenty of lubricant.
  • To prevent recurrence, the patient should be placed on stool softeners and should be instructed in the technique of manual self-reduction of prolapsed hemorrhoids, which may occur at each bowel movement.
• Complications and Management:
  Unsuccessful reduction
  • May result in infarction of prolapsed segment
  • Requires surgical management with excision of prolapsed portion

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