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Femoral Artery: The main artery of the thigh, a continuation of the external iliac artery.

Arterial Line Placement

JoVE 10178

Source: Sharon Bord, MD, Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Maryland, USA

When monitoring patients, it is important to obtain values that are accurate and reliable. Blood pressure monitoring is one of the essential vital signs, and for a majority of patients, measuring it utilizing non-invasive techniques provides accurate values. However, there are situations in which the blood pressure requires more exact, specific, and reliable measurements. This can be achieved by intra-arterial blood pressure monitoring and requires arterial line placement. Arterial line placement refers to the insertion of a catheter, which is able to transduce blood pressure, into one of the major arteries (e.g., radial or femoral artery). Patients who potentially need arterial line placement include those with extreme low (such as in sepsis or cardiogenic shock) or high (as in cerebrovascular accident or hypertensive emergency) blood pressure measurements. Many of these patients are placed on vasoactive medications to either increase or decrease blood pressure. When the goal is to decrease a patient's blood pressure, it must be done gradually, which further necessitates close blood pressure monitoring. Arterial line placement is also ideal for patients who require frequent arterial blood gas moni


 Emergency Medicine and Critical Care

Central Venous Catheter Insertion: Femoral Vein

JoVE 10240

Source: James W Bonz, MD, Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA

Central venous access is necessary in a multitude of clinical situations, including vascular access, vasopressor and caustic medication delivery, central venous pressure monitoring, volume resuscitation, total parental nutrition, hemodialysis, and frequent phlebotomy. There are three veins in the body that are accessed for central venous cannulation: the internal jugular, the subclavian, and the femoral. Each of these vessels has distinct advantages and disadvantages with unique anatomical considerations. Femoral vein cannulation can be easily performed both under ultrasound guidance and using the surface landmarks; therefore, femoral access is often used when emergent placement of a central venous catheter (CVC) is needed (such as in the case of medical codes and trauma resuscitations). In addition, cannulation of the femoral artery allows one to simultaneously perform other procedures needed for stabilization, such as cardiopulmonary resuscitation (CPR) and intubation. Successful placement of a femoral CVC requires working understanding of the target anatomy, access to with procedural ultrasound, and fluidity in the Seldinger technique. Seld


 Emergency Medicine and Critical Care

Peripheral Vascular Exam Using a Continuous Wave Doppler

JoVE 10123

Source: Joseph Donroe, MD, Internal Medicine and Pediatrics, Yale School of Medicine, New Haven, CT

Peripheral vascular disease (PVD) is a common condition affecting older adults and includes disease of the peripheral arteries and veins. While the history and physical exam offer clues to its diagnosis, Doppler ultrasound has become a routine part of the bedside vascular examination. The video titled "The Peripheral Vascular Exam" gave a detailed review of the physical examination of the peripheral arterial and venous systems. This video specifically reviews the bedside assessment of peripheral arterial disease (PAD) and chronic venous insufficiency using a handheld continuous wave Doppler. The handheld Doppler (HHD) is a simple instrument that utilizes continuous transmission and reception of ultrasound (also referred to as continuous wave Doppler) to detect changes in blood velocity as it courses through a vessel. The Doppler probe contains a transmitting element that emits ultrasound and a receiving element that detects ultrasound waves (Figure 1). The emitted ultrasound is reflected off of moving blood and back to the probe at a frequency directly related to the velocity of blood flow. The reflected signal is detected and transduced to an audible sound with a frequen


 Physical Examinations I

Abdominal Exam I: Inspection and Auscultation

JoVE 10088

Source: Alexander Goldfarb, MD, Assistant Professor of Medicine, Beth Israel Deaconess Medical Center, MA

Gastrointestinal disease accounts for millions of office visits and hospital admissions annually. Physical examination of the abdomen is a crucial tool in diagnosing diseases of the gastrointestinal tract; in addition, it can help identify pathological processes in cardiovascular, urinary, and other systems. As physical examination in general, the examination of the abdominal region is important for establishing physician-patient contact, for reaching the preliminary diagnosis and selecting subsequent laboratory and imaging tests, and determining the urgency of care. As with the other parts of a physical examination, visual inspection and auscultation of the abdomen are done in a systematic fashion so that no potential findings are missed. Special attention should be paid to potential problems already identified by the patient's history. Here we assume that the patient has already been identified, and has had history taken, symptoms discussed, and areas of potential concern identified. In this video we will not review the patient's history; instead, we will go directly to the physical examination. Before we get to the examination, let's briefly review s


 Physical Examinations II

Proper Adjustment of Patient Attire during the Physical Exam

JoVE 10147

Source: Jaideep S. Talwalkar, MD, and Joseph Donroe, MD, Internal Medicine and Pediatrics, Yale School of Medicine, New Haven, CT

In order to optimize the predictive value of the physical examination, the provider must perform maneuvers correctly. The proper use of drapes is an important component of correctly performing physical examination maneuvers. Skin lesions are missed when "inspection" occurs through clothing, crackles are erroneously reported when the lungs are examined through a t-shirt, and subtle findings on the heart exam go undetected when auscultation is performed over clothing. Accordingly, the best practice standards call for examining with one's hands or equipment in direct contact with the patient's skin (i.e., do not examine through a gown, drape, or clothing). In addition to its clinical value, the correct draping technique is important for improving the patient's comfort level during the encounter. Like all other aspects of the physical exam, it takes deliberate thought and practice to find the right balance between draping, which is done to preserve patient modesty, and exposure, which is necessary to optimize access to the parts that need examination. Individual provider styles in the use of gowns and drapes vary consider


 Physical Examinations I

Lymph Node Exam

JoVE 10061

Source: Richard Glickman-Simon, MD, Assistant Professor, Department of Public Health and Community Medicine, Tufts University School of Medicine, MA

The lymphatic system has two main functions: to return extracellular fluid back to the venous circulation and to expose antigenic substances to the immune system. As the collected fluid passes through lymphatic channels on its way back to the systemic circulation, it encounters multiple nodes consisting of highly concentrated clusters of lymphocytes. Most lymph channels and nodes reside deep within the body and, therefore, are not accessible to physical exam (Figure 1). Only nodes near the surface can be inspected or palpated. Lymph nodes are normally invisible, and smaller nodes are also non-palpable. However, larger nodes (>1 cm) in the neck, axillae, and inguinal areas are often detectable as soft, smooth, movable, non-tender, bean-shaped masses imbedded in subcutaneous tissue. Lymphadenopathy usually indicates an infection or, less commonly, a cancer in the area of lymph drainage. Nodes may become enlarged, fixed, firm, and/or tender depending on the pathology present. For example, a soft, tender lymph node palpable near the angle of the mandible may indicate an infected tonsil, whereas a firm, enlarged, non-tender lymph


 Physical Examinations II

Invasive Hemodynamic Characterization of the Portal-hypertensive Syndrome in Cirrhotic Rats

1Div. of Gastroenterology and Hepatology, Dept. of Internal Medicine III, Medical University of Vienna, Vienna, Austria, 2Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria, 3Center of Biomedical Research, Medical University of Vienna, Vienna, Austria

JoVE 57261


 Medicine

Utilizing the Modified T-Maze to Assess Functional Memory Outcomes After Cardiac Arrest

1Department of Neurology, Louisiana State University Health Science Center, 2Center for Brain Health, Louisiana State University Health Science Center, 3Department of Cellular Biology and Anatomy, Louisiana State University Health Science Center, 4Department of Neurology, Cerebral Vascular Disease Research Laboratories, University of Miami Miller School of Medicine, 5Department of Biomedical Sciences, West Virginia School of Osteopathic Medicine

JoVE 56694


 Behavior

Percutaneous Hepatic Perfusion (PHP) with Melphalan as a Treatment for Unresectable Metastases Confined to the Liver

1Department of Surgery, Leiden University Medical Centre, 2Department of Radiology, Leiden University Medical Centre, 3Department of Anesthesiology, Leiden University Medical Centre, 4Department of Extracorporeal Circulation, Leiden University Medical Centre, 5Department of Medical Oncology, Leiden University Medical Centre, 6Department of Surgery, Erasmus MC Cancer Institute

JoVE 53795


 Medicine

Ferric Chloride-induced Canine Carotid Artery Thrombosis: A Large Animal Model of Vascular Injury

1Department of Neurological Surgery, Ohio State University, 2Department of Surgery, Ohio State University, 3Department of Surgery, Duke University, 4Department of Internal Medicine, Ohio State University

JoVE 57981


 Medicine

In Vivo Model for Testing Effect of Hypoxia on Tumor Metastasis

1Department of Biochemistry and Molecular & Cellular Biology, Georgetown University Medical Center, 2Department of Nursing, Georgetown University, School of Nursing and Health Studies, 3Department of Human Science, Georgetown University, School of Nursing and Health Studies, 4School of Medicine, Georgetown University Medical Center, 5Department of Pathology and Neuropathology, Medical University of Gdańsk, 6Department of Oncology, Georgetown University Medical Center, 7Department of Pathology, Georgetown University Medical Center

JoVE 54532


 Cancer Research

Use of a Piglet Model for the Study of Anesthetic-induced Developmental Neurotoxicity (AIDN): A Translational Neuroscience Approach

1Department of Anesthesiology, Ohio State University College of Medicine, 2Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, 3Department of Anaesthesia and Critical Care Medicine, University of Toronto, 4Department of Biomedical Sciences, Section of Anatomic Pathology, Cornell University College of Veterinary Medicine, 5Department of Pathology and Anatomy, Ohio State University College of Medicine, 6Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital

JoVE 55193


 Medicine

Rodent Handling and Restraint Techniques

JoVE 10221

Source: Kay Stewart, RVT, RLATG, CMAR; Valerie A. Schroeder, RVT, RLATG. University of Notre Dame, IN 

It has been demonstrated that even minimal handling of mice and rats is stressful to the animals. Handling for cage changing and other noninvasive procedures causes an increase in heart rate, blood pressure, and other physiological parameters, such as serum corticosterone levels. Fluctuations can continue for up to several hours. The methods of restraint required for injections and blood withdrawals also cause physiological changes that can potentially affect scientific data. Training in the proper handling of mice and rats is required to minimize the effects to the animals.1 Mice and rats can be restrained manually with restraint devices, or with chemical agents. Manual methods and the use of restraint devices are covered in this manuscript. All restraint methods include the process of lifting the animals from their home cage.


 Lab Animal Research

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

1Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 2Department of Echocardiography, Shanghai Institute of Medical imaging, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 3Department of Cardiac surgery, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University

JoVE 56439


 Biology

Evaluation of a Novel Laser-assisted Coronary Anastomotic Connector - the Trinity Clip - in a Porcine Off-pump Bypass Model

1Department of Cardiothoracic Surgery, University Medical Center Utrecht, 2Vascular Connect b.v., 3Department of Neurosurgery, University Medical Center Utrecht, 4Department of Experimental Cardiology, University Medical Center Utrecht

JoVE 52127


 Medicine

Paradigms of Lower Extremity Electrical Stimulation Training After Spinal Cord Injury

1Spinal Cord Injury and Disorders Service, Hunter Holmes McGuire VAMC, 2Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, 3Deceased, Department of Kinesiology, The University of Georgia, 4Department of Physical Medicine and Rehabilitation, Penn State Milton S. Hershey Medical Center

JoVE 57000


 Behavior

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

1Institute of Neuroradiology, University Medical Center Goettingen, 2Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 3Department of Neurology, University Medical Center Goettingen, 4Department of Epidemiology, Helmholtz Center for Infection Research, 5Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, 6Department of Anesthesiology, University Medical Center Goettingen

JoVE 56397


 Neuroscience

Cardiopulmonary Bypass in a Mouse Model: A Novel Approach

1Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, 2Department of Hematology, Oncology, Immunology, Rheumatology, and Pulmonology, University Hospital Tuebingen, 3Department of Pneumology, Hannover Medical School

JoVE 56017


 Medicine

Combined Intravital Microscopy and Contrast-enhanced Ultrasonography of the Mouse Hindlimb to Study Insulin-induced Vasodilation and Muscle Perfusion

1Laboratory for Physiology, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, 2Department of Internal Medicine, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center

JoVE 54912


 Medicine

Murine Aortic Crush Injury: An Efficient In Vivo Model of Smooth Muscle Cell Proliferation and Endothelial Function

1Department of Surgery, Baltimore Veterans Affairs Medical Center, 2Department of Surgery, University of Maryland School of Medicine, 3Department of Physiology, University of Maryland School of Medicine, 4Center for Vascular and Inflammatory Diseases, University of Maryland School of Medicine

JoVE 55201


 Biology

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