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5
51

Anaesthesia choice in Total Hip Replacement

The choice of anaesthetic in primary total hip replacement surgery – which gives the best perioperative outcome?  
Zara Edwards
almost 10 years ago
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8
77

Cauda Equina Syndrome

Cauda Equina Syndrome Ben Savage  
Dr Ben Savage
about 9 years ago
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8
125

Shoulder Dislocations

Shoulder Dislocations Ben Savage  
Dr Ben Savage
about 9 years ago
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4
140

Haemothorax

This image displays a large left sided haemothorax with mediastinal displacement to the opposite side. Clinically the patient would be in respiratory distress - percussion of the left side of the chest would be dull and breath sounds and vocal resonance would be reduced. A Haemothorax such as this falls into the category of life threatening chest injuries (ATOMFC) and requires emergent treatment using a chest drain in the 5th intercostal space, mid-axillary line and treatment according to ALS or ATLS protocols. ATOMFC = A = airway obstruction, T = tension pneumothorax, O = open pneumothorax, M = massive haemothorax, F = flail chest, C = cardiac tamponade.  
Rhys Clement
almost 9 years ago
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12
789

Pleural effusion x-ray (left-sided)

This PA Chest X-Ray demonstrates a left sided pleural effusion. In this condition fluid collects between the parietal and visceral pleura and appears as a shadowy fluid level on the X-Ray with obliteration of the costophrenic angles. If you were to examine this patient they might be in respiratory distress from reduced oxygen uptake (so have low sats, high resp rate, possible cyanosis and accessory muscle useage) - they may have reduced chest expansion on the affected side and it would be stony dull to percussion. Fluid transmits sound poorly so breath sounds would be decreased as would vocal resonance/fremitus. Someone with consolidation may have very similar clinical findings but the underlying area of lung is almost solid due to pus from the infective process - as sounds travel well through solids they would have increased vocal fremitus which is how you can clinically differentiate between the two conditions. Clinical examination and understanding of conditions is paramount to practice effective medicine. Before you recieved this X-Ray you should be able to diagnose the condition and use the X-Ray to confirm your suspicions.  
Rhys Clement
almost 9 years ago
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9
320

CXR - left sided pneumothorax and surgical emphysema

In this Chest X-Ray we can identify a left sided pneumothorax - there is absence of lung markings in the periphery and we can also see a shadow which outlines the edge of the lung. A pneumothorax is caused when air enters the potential space between the viceral and parietal pleura and causes the lung to collapse down under the pressure of it's elsatic recoil. In this case it is likely that the pneumothorax has been caused by trauma as we can see air in the soft tissues on the left side (surgical emphysema - clinically feels like bubble wrap). A pneumothorax can be a life threatening condition. The patient presents in respiratory distress with decreased expansion on the affected side. There will be hyperresonance to percussion on that side but absent breath sounds. The emergency treatment is decompression with a large bore cannula in the 2nd intercostal space mid-clavicular line followed by insertion a chest drain in the 5th intercostal space mid-axilllary line  
Rhys Clement
almost 9 years ago
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4
112

Chest X-ray

Note the calcified granuloma in the right upper zone (an important differential being malignancy). Note also the left lower lobe collapse ('sail sign' behind the heart). If you look closely you will see the abscence of the lower ribs leading you to the conclusion that the patient has, at some point, undergone a thoracotomy. You can also see surgical clips in the stomach.  
Tim Ritzmann
almost 9 years ago
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10
90

Hip Fracture

Left intracapsular neck of femur fracture. This is a common injury which it is important to recognise on imaging. It has a relatively poor prognosis and intracapsular fractures are particularly at risk of avascular necrosis of the hip. Early intervention is therefore important - consider which may be the appropriate treatment approaches in this case?  
Tim Ritzmann
almost 9 years ago
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6
98

Chest x-Ray

Left Sided Pleural effusion. The most common cause of this presentation is malignancy. It is important to consider the source of a possible primary. It may also be necessary to obtain a sample of the effusion fluid to determine whether it is a transudate or an exudate, using Light's criteria as a guide. Exudate contains greater levels of protein than a transudate reflecting it's often inflammatory origin as the blood vessels become 'leaky' to protein molecules. The differential diagnosis for bilateral pleural effusions is different again. Consider 'failure' e.g. heart, renal or hepatic.  
Tim Ritzmann
almost 9 years ago
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6
54

London classification of PIPJ fracture

London classification of PIPJ fracture  
Chris Oliver
over 8 years ago
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4
32

Bennetts Fracture Thumb Ckassiification

Bennetts Fracture Thumb Ckassiification  
Chris Oliver
over 8 years ago
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3
157

Salter Harris Classification epiphyseal injuries

Salter Harris Classification epiphyseal injuries  
Chris Oliver
over 8 years ago
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2
21

Congenital Pseudoarthrosis Clavicle

Congenital Pseudoarthrosis Clavicle  
Chris Oliver
over 8 years ago
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3
36

Review of orthopaedic services: Prepared for the Auditor General for Scotland. March 2010

Review of orthopaedic services: Prepared for the Auditor General for Scotland. March 2010. Website http://www.audit-scotland.gov.uk/media/article.php?id=128 "In recent years, the National Health Service (NHS) in Scotland has significantly reduced the length of time people are waiting to receive orthopaedic procedures such as hip replacements and knee operations. Over 95% of patients are now treated within 26 weeks of referral, compared to only 66% in 2003. But there is scope to make savings by working more efficiently. An Audit Scotland report, Review of orthopaedic services, says there is high demand for these services. Orthopaedic care is particularly important for older people, who have the highest rates of fractures and joint replacement."  
Chris Oliver
over 8 years ago
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1
18

Solution for patients with missing teeth and bone loss

In this episode, Dr. Kazemi discusses a common challenge for many patients with missing teeth and bone loss.&nbsp; A case is presented reviewing various bone augmentation techniques and dental implants to replace the missing teeth for a life-long solution. Success depends on&nbsp; thorough diagnosis, careful planning, close collaboration between team of expert dentists, and skillful surgeries and treatments.<br/>  
H. Ryan Kazemi, Dmd
about 8 years ago
5
2
21

Climbing Everest

Terry OConnor talks with ercast about climbing Mt Everest and being an expedition physician<br><br>An experience with delayed sequence intubation<br><br>Rob is interviewed on <a href="http://www.skepreview.com/2010/06/interview-with-dogma-free-americas-dr.html">The Skeptical Review</a> website<br><br>A letter from Dr. Ken Walker about the international emergency medicine and the&nbsp;<a href="http://www.pfid.net/">Partners for International Development</a>  
Rob Orman, MD
about 8 years ago
0
1
16

Episode 2--Pediatric Limp

<p>How do you workup a child with limp?&nbsp;</p <p>Decisions rules for distinguishing between toxic synovitis and septic hip.</p <p>&nbsp;</p <p>A curbside consult with pediatric orthopedic surgeon Adam Barmada</p <p>&nbsp;</p <p>Listener email and much more</p <p>&nbsp;</p <p>&nbsp;</p <p>&nbsp;</p <p>&nbsp;</p>  
Rob Orman, MD
about 8 years ago
5
1
5

SABCS 2008 | Case04

ResearchToPractice.com/SABCS_2008 – Second Opinion: Proceedings and Interviews from a 2-Part CME Satellite Symposia Held at the 31st Annual San Antonio Breast Cancer Symposium. Case: 65-year-old woman with rapidly progressive, symptomatic bone and lung metastases after recurrence during her fifth year of an adjuvant aromatase inhibitor for ER/PR-positive, HER2-negative BC. Interviews conducted by Neil Love, MD. Produced by Research To Practice.  
Dr Neil Love
about 8 years ago
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1
9

SABCS 2008 | Case06

ResearchToPractice.com/SABCS_2008 – Second Opinion: Proceedings and Interviews from a 2-Part CME Satellite Symposia Held at the 31st Annual San Antonio Breast Cancer Symposium. Case: 47-year-old postmenopausal woman with a 1.8-cm, ER/PR-positive, HER2-negative, node-negative BC who developed bone metastases after four years of an adjuvant aromatase inhibitor. Interviews conducted by Neil Love, MD. Produced by Research To Practice.  
Dr Neil Love
about 8 years ago