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Patient Satisfaction: The degree to which the individual regards the health care service or product or the manner in which it is delivered by the provider as useful, effective, or beneficial.

Description of a Novel, Surgically Implanted Neuromodulatory Technique Known As Bilateral Epidural Prefrontal Cortical Stimulation (Epcs) for Treatment-Resistant Depression (TRD)

1Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 2Department of Neurosciences, Medical University of South Carolina, 3Ralph H. Johnson VA Medical Center, 4Department of Psychiatry and Behavioral Sciences, Stanford University, 5American University of Beirut Medical Center

Video Coming Soon

JoVE 56043


 JoVE In-Press

The Multiple Sclerosis Performance Test (MSPT): An iPad-Based Disability Assessment Tool

1Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, 2Center for Brain Health, Cleveland Clinic Foundation, 3Quantitative Health Sciences, Cleveland Clinic Foundation, 4Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic Foundation

JoVE 51318


 Medicine

Exergaming in Older People Living with HIV Improves Balance, Mobility and Ameliorates Some Aspects of Frailty

1Department of Surgery, Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), College of Medicine, University of Arizona, 2Department of Medicine, Division of Infectious Disease, College of Medicine, University of Arizona, 3Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine

JoVE 54275


 Medicine

Voluntary Breath-hold Technique for Reducing Heart Dose in Left Breast Radiotherapy

1Department of Radiotherapy, Royal Marsden NHS Foundation Trust, 2Centre for Vision, Speech and Signal Processing, Faculty of Engineering and Physical Sciences, University of Surrey, 3Clinical Trials and Statistics Unit (ICR-CTSU), Institute of Cancer Research, Sutton, UK, 4Division of Radiotherapy and Imaging, Institute of Cancer Research, Sutton, UK

JoVE 51578


 Medicine

Creating Dynamic Images of Short-lived Dopamine Fluctuations with lp-ntPET: Dopamine Movies of Cigarette Smoking

1Diagnostic Radiology, Yale University, 2Psychiatry, Yale University, 3Yale PET Center, Yale University, 4Biomedical Engineering, Yale University, 5Nuclear Medicine, Massachusetts General Hospital, 6Radiological Sciences, University of California, Irvine

JoVE 50358


 Behavior

Surgical Fixation of Sternal Fractures: Preoperative Planning and a Safe Surgical Technique Using Locked Titanium Plates and Depth Limited Drilling

1Orthopedic and Trauma Surgery, University Hospital Erlangen, 2Pediatric Surgery, University Hospital Erlangen, 3Orthopedic and Trauma Surgery, St.-Theresien Hospital, 4Institute of Anatomy I, University Erlangen-Nuremberg

JoVE 52124


 Medicine

Scanning Light Scattering Profiler (SLPS) Based Methodology to Quantitatively Evaluate Forward and Backward Light Scattering from Intraocular Lenses

1Office of Device Evaluation, Center for Devices and Radiological Health, U.S. Food and Drug Administration, 2Optical Therapeutics and Medical Nanophotonics Laboratory, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration

JoVE 55421


 Engineering

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A Novel Method for Involving Women of Color at High Risk for Preterm Birth in Research Priority Setting

1School of Nursing, University of California, San Francisco, 2UCSF California Preterm Birth Initiative, University of California, San Francisco, 3School of Medicine, University of California, San Francisco, 4San Francisco Black Infant Health Program, 5Homeless Prenatal Program

Video Coming Soon

JoVE 56220


 JoVE In-Press

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Motor Exam II

JoVE 10095

Source:Tracey A. Milligan, MD; Tamara B. Kaplan, MD; Neurology, Brigham and Women's/Massachusetts General Hospital, Boston, Massachusetts, USA

There are two main types of reflexes that are tested on a neurological examination: stretch (or deep tendon reflexes) and superficial reflexes. A deep tendon reflex (DTR) results from the stimulation of a stretch-sensitive afferent from a neuromuscular spindle, which, via a single synapse, stimulates a motor nerve leading to a muscle contraction. DTRs are increased in chronic upper motor neuron lesions (lesions of the pyramidal tract) and decreased in lower motor neuron lesions and nerve and muscle disorders. There is a wide variation of responses and reflexes graded from 0 to 4+ (Table 1). DTRs are commonly tested to help localize neurologic disorders. A common method of recording findings during the DTR examination is using a stick figure diagram. The DTR test can help distinguish upper and lower motor neuron problems, and can assist in localizing nerve root compression as well. Although the DTR of nearly any skeletal muscle could be tested, the reflexes that are routinely tested are: brachioradialis, biceps, triceps, patellar, and Achilles (Table 2). Superficial reflexes are segmental ref


 Physical Examinations III

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Elbow Exam

JoVE 10207

Source: Robert E. Sallis, MD. Kaiser Permanente, Fontana, California, USA

The elbow is a hinged joint that involves the articulation of 3 bones: the humerus, radius, and ulna. It is a much more stable joint than the shoulder, and because of that, the elbow has less range of motion. The elbow and its structures are prone to significant injuries, particularly with repetitive motion. Lateral and medial epicondylitis (also called tennis elbow and golfer's elbow) are two common diagnoses and often occur as a result of occupational activities. When examining the elbow, it is important to remove enough clothing so that the entire shoulder and elbow can be inspected. It is important to compare the injured elbow to the uninvolved side. A systematic evaluation of the elbow includes inspection, palpation, range of motion (ROM) testing, and special tests, including maneuvers to evaluate ligamentous stability and stretch tests to accentuate pain caused by epicondylitis.


 Physical Examinations III

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Comprehensive Breast Exam

JoVE 10118

Source:
Alexandra Duncan, GTA, Praxis Clinical, New Haven, CT
Tiffany Cook, GTA, Praxis Clinical, New Haven, CT
Jaideep S. Talwalkar, MD, Internal Medicine and Pediatrics, Yale School of Medicine, New Haven, CT

Breast exams are a key part of an annual gynecological exam and are important for all patients, no matter their sex or gender expression. One out of every 8 women will be diagnosed with breast cancer; male breast cancer, though less common, has a lifetime incidence of 1 in 1000. Breast exams can feel invasive to patients, so it is important to do everything possible to make the patients feel comfortable and empowered, rather than vulnerable. Examiners should be aware of what they are communicating, both verbally and non-verbally, and give their patients control wherever possible (for instance, always allowing them to remove their own gowns). Examiners may choose to utilize chaperones for the patients' (as well as their own) comfort. Some institutions require the use of chaperones. While it is always important to avoid overly clinical language, certain colloquial words can cross the line from caring to overly intimate in this exam. It is helpful to avoid the words "touch" and "feel" in this exam, as this lan


 Physical Examinations II

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Safety Checks and Five Rights of Medication Administration

JoVE 10235

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

According to the 1999 Institution of Medicine (IOM) report titled To Err is Human: Building a Safer Health System, medication errors are significant contributors to avoidable patient deaths in the hospital environment. Therefore, to maintain patient safety and to avoid medication errors, it is important that every nurse adheres to at least five "rights" of safe medication administration. These five "rights" refer to the right patient, right medication, right medication dose, right time of administration, and right route of administration. The nurse should check for these five "rights" at three different checkpoints points in the mediation administration process: 1) while comparing the Medication Administration Record (MAR) when withdrawing medications, 2) while comparing the MAR to acquired medications, and 3) while comparing the MAR to both the medication and patient identifiers at the bedside. This video will demonstrate the acquisition component of medication administration, which consists of performing the five "rights" during the first, second, and third checkpoints. Prior to acquiring medications from a medication dispensing system (M


 Nursing Skills

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Preparing and Administering Topical Medications

JoVE 10259

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

Topical medications are applied directly to the body surfaces, including the skin and mucous membranes of the eyes, ears, nose, vagina, and rectum. There are many classes of topical medications, such as creams, ointments, lotions, patches, and aerosol sprays. Medications that are applied to the skin to produce slow, controlled, systemic effect are also referred to as transdermal. Transdermal absorption can be altered if lesions, burns, or breakdowns are present at the application site. Many transdermal medications are delivered via adhesive patch to achieve the slow, controlled, systemic effect. The patch should be applied to clean and hairless skin areas that do not undergo excessive movement, such as the back of the shoulder or thigh. Other topical creams or eye ointments should be applied according to the packaging and manufacturer instructions using an application device. When instilling eardrop medications, never occlude the ear canal, as this may increase pressure and rupture the ear drum. Medications that can be administered via a topical route include antibiotics, narcotics, hormones, and even chemotherapeutics. This requires adherence to the five "rights" of medicati


 Nursing Skills

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Motor Exam I

JoVE 10052

Source:Tracey A. Milligan, MD; Tamara B. Kaplan, MD; Neurology, Brigham and Women's/Massachusetts General Hospital, Boston, Massachusetts, USA

Abnormalities in the motor function are associated with a wide range of diseases, from movement disorders and myopathies to strokes. The motor assessment starts with observation of the patient. When the patient enters the examination area, the clinician observes the patient's ability to walk unassisted and the speed and coordination while moving. Taking the patient's history provides an additional opportunity to observe for evidence of tremors or other abnormal movements, such as chorea or tardive dyskinesia. Such simple but important observations can yield valuable clues to the diagnosis and help to focus the rest of the examination. The motor assessment continues in a systematic fashion, including inspection for muscle atrophy and abnormal movements, assessment of muscle tone, muscle strength testing, and finally the examination of the muscle reflexes and coordination. The careful systematic testing of the motor system and the integration of all the findings provide insight to the level at which the motor pathway is affected, and also help the clinician to formulate the differential diagnosis and determine the course of the subsequent evaluation and treatment.


 Physical Examinations III

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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

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Cranial Nerves Exam I (I-VI)

JoVE 10091

Source:Tracey A. Milligan, MD; Tamara B. Kaplan, MD; Neurology, Brigham and Women's/Massachusetts General Hospital, Boston, Massachusetts, USA

During each section of the neurological testing, the examiner uses the powers of observation to assess the patient. In some cases, cranial nerve dysfunction is readily apparent: a patient might mention a characteristic chief complaint (such as loss of smell or diplopia), or a visually evident physical sign of cranial nerve involvement, such as in facial nerve palsy. However, in many cases a patient's history doesn't directly suggest cranial nerve pathologies, as some of them (such as sixth nerve palsy) may have subtle manifestations and can only be uncovered by a careful neurological exam. Importantly, a variety of pathological conditions that are associated with alterations in mental status (such as some neurodegenerative disorders or brain lesions) can also cause cranial nerve dysfunction; therefore, any abnormal findings during a mental status exam should prompt a careful and complete neurological exam. The cranial nerve examination is applied neuroanatomy. The cranial nerves are symmetrical; therefore, while performing the examination, the examiner should compare each side to the other. A physician should approach the examination in a


 Physical Examinations III

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Preparing and Administering Subcutaneous Medications

JoVE 10234

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

Subcutaneous medication administration is a parenteral approach to administer small amounts of medication (less than 2 mL) into the layer of tissue just below the skin. Common medications administered via the subcutaneous route include anticoagulant medications, such as heparin or enoxaparin; epinephrine administered for allergic reactions; insulin; and some immunizations. Subcutaneous injection preparations are commonly provided in vials or ampules for withdrawal into a subcutaneous syringe. Subcutaneous needles have a shorter length and smaller diameter than syringes used for intramuscular injections, are typically less than 5/8th of an inch, and are 26 gauge or smaller. Medication absorption and onset is slower than for intravenous routes, with some absorption rates lasting 24 h or longer. This approach is selected for many medications that may be denatured or deactivated if given via the oral route, given the acidity of the gastrointestinal tract. Subcutaneous injection preparations are commonly provided in vials or ampules for withdrawal into a subcutaneous syringe. The nurse should determine the appropriate medication dose according to


 Nursing Skills

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Preparing and Administering Oral Tablet and Liquid Medications

JoVE 10258

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

Oral medications are the route most preferred by patients and are one of the most commonly used routes of medication administration by providers. Most oral preparations are taken by mouth, swallowed with fluid, and absorbed via the gastrointestinal tract. Oral medications are available in solid forms (e.g., tablets, capsules, caplets, and enteric-coated tablets) and liquids forms (e.g., syrups, elixirs, spirits, and suspensions). Most oral medications have a slower onset of action and, in the case of liquids and swallowed oral medications, may also have a more prolonged effect. Enteric-coated tablets are covered with material that prevents dissolution and absorption until the tablet reaches the small intestine. Additional oral medication routes (not shown in this video) include sublingual administration, in which the preparation is placed under the tongue to dissolve, and buccal administration, which involves placing the medication in the cheek area between the gums and mucus membranes to dissolve. When preparing and administering oral tablets and liquid medications, the nurse must consider whether the medication is appropriate given the patient's medical conditi


 Nursing Skills

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Pelvic Exam I: Assessment of the External Genitalia

JoVE 10144

Source:
Alexandra Duncan, GTA, Praxis Clinical, New Haven, CT
Tiffany Cook, GTA, Praxis Clinical, New Haven, CT
Jaideep S. Talwalkar, MD, Internal Medicine and Pediatrics, Yale School of Medicine, New Haven, CT

The pelvic exam can feel invasive to patients, so it is important to do everything possible to make patients feel comfortable and empowered, rather than vulnerable. Clinicians should be aware of how they are communicating, both verbally and nonverbally, and should give their patients control whenever possible. There are many ways to do this, from how the exam table is positioned to how the patient is engaged throughout the exam. As many as 1 in 5 patients may have experienced sexual trauma; therefore, it is important to avoid triggering those patients, but it's not always possible to know who they are. The exam in this video demonstrates neutral language and techniques that can be employed with all patients to create the best experience possible. It's important to keep the patient covered wherever possible and to minimize extraneous contact. A clinician should be careful to tuck fingers that aren't being used to examine the patient to avoid accidental contact with the clitoris or anus. Before performing the pelvic e


 Physical Examinations II

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Preparing and Administering Enteric Tube Medications

JoVE 10287

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

An enteric tube is a tube that is inserted and passed into the stomach or intestines. Enteric tubes serve multiple purposes, including stomach decompression (through the removal of air, gastric contents, and secretions), enteric feeding, and/or the administration of medications or oral contrast. Enteric tubes are indicated for patients with impaired swallowing and for patients with neurological or other conditions associated with an increased risk of aspiration, or when the patient is unable to maintain adequate oral intake of fluid or calories. There are multiple types of enteric tubes, with their generic names assigned according to the insertion site and the gastrointestinal termination point. For instance, one of the common tube types is the nasogastric tube, which is inserted through a nostril and passed along the upper gastrointestinal tract into the stomach. When administering medications through an enteric tube, it is important to ensure that the tube terminates in the intended gastrointestinal location. When enteric tubes are initially placed, the position of the tube is verified by X-ray. However, due to gastric peristalsis, enteric tubes may migrate out of their intended


 Nursing Skills

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Interictal High Frequency Oscillations Detected with Simultaneous Magnetoencephalography and Electroencephalography as Biomarker of Pediatric Epilepsy

1Fetal-Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, 2Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 3Division of Epilepsy Surgery, Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, 4Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School

JoVE 54883


 Medicine

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Preparing and Administering Intramuscular Injections

JoVE 10261

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

Intramuscular (IM) injections deposit medications deep into the muscle tissue. Since muscle fibers are well perfused, this route of administration provides quick uptake of the medication and allows for the administration of relatively large volumes. Skeletal muscles have fewer pain-sensing nerves than subcutaneous tissue, which allows for the less painful administration of irritating drugs (e.g., chlorpromazine, an anti-psychotic). IM injections are recommended for patients unable to take oral medications and for uncooperative patients. Some examples of medications that are commonly delivered by IM injections include antibiotics, hormones, and vaccinations. As in any other route of administration, the nurse must consider if the medication is appropriate, given the patient's medical conditions, allergies, and current clinical status. In addition, specifically for IM injections, it is important to assess the patient's muscle mass to determine the appropriate needle size. Also, if the patient has already received this injection, it is necessary to verify the injection site that was previously used and to ensure that the previous dose did not result in any adverse


 Nursing Skills

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Preparing and Administering Inhaled Medications

JoVE 10390

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT

Inhaled medications are prescribed for conditions affecting the bronchi, which branch off of the trachea, and bronchioles, which are progressively smaller conducting airways spread throughout the lung tissue. These conditions can be classified as acute (i.e., temporary, with quick onset) or chronic (i.e., persistent and/or recurrent symptoms lasting months to years). Common acute conditions requiring inhaled medications include acute bronchitis, pneumonia, tuberculosis, pulmonary edema, and acute respiratory distress syndrome. Chronic conditions requiring inhaled medications encompass those classified as COPD (i.e., asthma, chronic bronchitis, and emphysema), as well as other chronic conditions, including cystic fibrosis, lung cancer, and pneumoconiosis. These conditions often require medications to open airways, decrease airway inflammation, and promote airflow. The delivery of medications directly into the airways allows for a faster response when compared to systemically administered medications and decreases the impact of systemic side effects. Inhaled medications come in different forms and delivery devices. Common inhaled medications include short- and


 Nursing Skills

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Knee Exam

JoVE 10203

Source: Robert E. Sallis, MD. Kaiser Permanente, Fontana, California, USA

The knee is a hinged joint that connects the femur with the tibia. It is the largest joint in the body, and due to its location in the middle of the lower leg, it is subjected to a variety of traumatic and degenerative forces. Examination of the knee can be quite complex, owing to the fact it is an inherently unstable joint held together by various ligaments and supported by menisci, which act as shock absorbers and increase the contact area of the joint. In addition, the patella lies in front of the knee, acting as a fulcrum to allow the forceful extension of the knee needed for running and kicking. As the largest sesamoid bone in the body, the knee is a common source of pain related to trauma or overuse. When examining the knee, it is important to remove enough clothing so that the entire thigh, knee, and lower leg are exposed. The exam begins with inspection and palpation of key anatomic landmarks, followed by an assessment of the patient's range of motion (ROM). The knee exam continues with tests for ligament or meniscus injury and special testing for patellofemoral dysfunction and dislocation of the patella. The opposite knee should be used as the standard to evaluate the injured knee, provided it has not been previousl


 Physical Examinations III

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Quantitative Magnetic Resonance Imaging of Skeletal Muscle Disease

1Institute of Imaging Science, Vanderbilt University, 2Department of Radiology and Radiological Sciences, Vanderbilt University, 3Department of Biomedical Engineering, Vanderbilt University, 4Department of Molecular Physiology and Biophysics, Vanderbilt University, 5Department of Physical Medicine and Rehabilitation, Vanderbilt University, 6Department of Physics and Astronomy, Vanderbilt University

JoVE 52352


 Medicine

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Sensory Exam

JoVE 10113

Source:Tracey A. Milligan, MD; Tamara B. Kaplan, MD; Neurology, Brigham and Women's/Massachusetts General Hospital, Boston, Massachusetts, USA

A complete sensory examination consists of testing primary sensory modalities as well as cortical sensory function. Primary sensory modalities include pain, temperature, light touch, vibration, and joint position sense. Sensation of the face is discussed in the videos Cranial Nerves Exam I and II, as are the special senses of smell, vision, taste, and hearing. The spinothalamic tract mediates pain and temperature information from skin to thalamus. The spinothalamic fibers decussate (cross over) 1-2 spinal nerve segments above the point of entry, then travel up to the brainstem until they synapse on various nuclei in thalamus. From the thalamus, information is then relayed to the cortical areas such as the postcentral gyrus (also known as the primary somatosensory cortex). Afferent fibers transmitting vibration and proprioception travel up to medulla in the ipsilateral posterior columns as fasciculus gracilis and fasciculus cuneatus, which carry information from the lower limbs and upper limbs, respectively. Subsequently, the afferent projections cross over and ascend to the thalamus, and from there to the primary somatosensory cortex. The pattern of a


 Physical Examinations III

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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

Video Coming Soon

JoVE 56397


 JoVE In-Press

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Quantification of the Immunosuppressant Tacrolimus on Dried Blood Spots Using LC-MS/MS

1iC42 Clinical Research and Development, University of Colorado, Anschutz Medical Campus, 2Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, 3Food and Drug Administration (FDA), Center of Drug Evaluation Research - Office of Generic Drugs, 4Transplant Clinical Research, University of Cincinnati

JoVE 52424


 Medicine

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Abdominal Exam IV: Acute Abdominal Pain Assessment

JoVE 10120

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

Abdominal pain is a frequent presenting concern in both the emergency department and the office setting. Acute abdominal pain is defined as pain lasting less than seven days, while an acute abdomen refers to the abrupt onset of severe abdominal pain with features suggesting a surgically intervenable process. The differential diagnosis of acute abdominal pain is broad; thus, clinicians must have a systematic method of examination guided by a careful history, remembering that pathology outside of the abdomen can also cause abdominal pain, including pulmonary, cardiac, rectal, and genital disorders. Terminology for describing the location of abdominal tenderness includes the right and left upper and lower quadrants, and the epigastric, umbilical, and hypogastric regions (Figures 1, 2). Thorough examination requires an organized approach involving inspection, auscultation, percussion, and palpation, with each maneuver performed purposefully and with a clear mental representation of the anatomy. Rather than palpating randomly across the abdomen, begin palpating remotely from the site of tenderness, moving systematically toward the tender region, and thi


 Physical Examinations II

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Cranial Nerves Exam II (VII-XII)

JoVE 10005

Source:Tracey A. Milligan, MD; Tamara B. Kaplan, MD; Neurology, Brigham and Women's/Massachusetts General Hospital, Boston, Massachusetts, USA

The cranial nerve examination follows the mental status evaluation in a neurological exam. However, the examination begins with observations made upon greeting the patient. For example, weakness of the facial muscles (which are innervated by cranial nerve VII) can be readily apparent during the first encounter with the patient. Cranial nerve VII (the facial nerve) also has sensory branches, which innervate the taste buds on the anterior two-thirds of the tongue and the medial aspect of the external auditory canal. Therefore, finding ipsilateral taste dysfunction in a patient with facial weakness confirms the involvement of cranial nerve VII. In addition, knowledge of the neuroanatomy helps the clinician to localize the level of the lesion: unilateral weakness of the lower facial muscles suggests a supranuclear lesion on the opposite side, while lesions involving the nuclear or infranuclear portion of the facial nerve manifest with an ipsilateral paralysis of all the facial muscles on the involved side. Cranial nerve VIII (the acoustic nerve) has two divisions: the hearing (cochlear) division and the vestibular division, which innervates the semi


 Physical Examinations III

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Pelvic Exam III: Bimanual and Rectovaginal Exam

JoVE 10163

Source:

Alexandra Duncan, GTA, Praxis Clinical, New Haven, CT

Tiffany Cook, GTA, Praxis Clinical, New Haven, CT

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

A bimanual exam is a thorough check of a patient's cervix, uterus, and ovaries. It can tell an experienced provider a great deal, as it may lead to the discovery of abnormalities, such as cysts, fibroids, or malignancies. However, it's useful even in the absence of such findings, as it allows the practitioner to establish an understanding of the patient's anatomy for future reference. Performing the bimanual exam before the speculum exam can help relax patients, mentally and physically, before what is often perceived as the "most invasive" part of the exam. A practitioner already familiar with the patient's anatomy can insert a speculum more smoothly and comfortably. However, lubrication used during the bimanual exam may interfere with processing certain samples obtained during the speculum exam. Providers must be familiar with local laboratory processing requirements before committing to a specific order of examination. This demonstration begins


 Physical Examinations II

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Abdominal Exam III: Palpation

JoVE 10089

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

Abdominal palpation, if performed correctly, allows for examination of the large and relatively superficial organs; for a skilled examiner, it allows for assessment of the smaller and deeper structures as well. The amount of information that can be obtained by palpation of the abdominal area also depends on the anatomical characteristics of the patient. For example, obesity might make palpation of internal organs difficult and require that additional maneuvers be performed. Abdominal palpation provides valuable information regarding localization of the problem and its severity, as abdominal palpation identifies the areas of tenderness as well as presence of organomegaly and tumors. The specific focus of palpation is driven by the information collected during history taking and other elements of the abdominal exam. Palpation helps to integrate this information and develop the strategy for subsequent diagnostic steps.


 Physical Examinations II

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