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Pubic Symphysis:

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

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

Abdominal Exam II: Percussion

JoVE 10090

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

Medical percussion is based on the difference in pitch between the sounds elicited by tapping on the body wall. The auditory response to tapping depends on the ease with which the body wall vibrates, and is influenced by underlying organs, strength of the stroke, and the state of the body wall. There are three main medical percussion sounds: resonance (heard over lungs), tympany (heard over the air-filled bowel loops), and dullness (heard over fluid or solid organs). The contrast between dullness vs. tympany or resonance allows for determination of the size and margins of organs and masses, as well as identification of fluid accumulation and areas of consolidation. Percussion remains an intricate part of the physical diagnosis since it was first introduced more than 200 years ago, and is especially useful in examination of the lungs and abdomen. As a part of an abdominal examination, percussion follows visual inspection and auscultation. The examiner should first percuss over each of the nine abdominal regions (epigastric region, right hypochondriac region, left hypochondriac region, umbilical region, right lumbar region, left lumbar region, hypogastric region, right inguinal region, and left


 Physical Examinations II

Cystometric and External Urethral Sphincter Measurements in Awake Rats with Implanted Catheter and Electrodes Allowing for Repeated Measurements

1Department of Urology, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, 2Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, 3Brain Research Institute, University of Zürich, 4Department of Health Sciences and Technology, Swiss Federal Institute of Technology Zürich, 5Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, 6Department of Orthopaedics and Traumatology, Dhulikhel Hospital, Kathmandu University Hospital, 7Department of Urology, Inselspital, Bern University Hospital

Video Coming Soon

JoVE 56506


 JoVE In-Press

A Model of Free Tissue Transfer: The Rat Epigastric Free Flap

1Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa, 2Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central - Hospital de São José, 3UCIBIO, Life Sciences Department, Faculty of Sciences and Technology, Universidade NOVA de Lisboa, 4CEDOC, NOVA Medical School, Universidade NOVA de Lisboa, 5Physics Department, Faculty of Sciences and Technology, LIBPhys, 6Pathology Department, Centro Hospitalar de Lisboa Central – Hospital de São José

JoVE 55281


 Medicine

Normothermic Ex Vivo Kidney Perfusion for the Preservation of Kidney Grafts prior to Transplantation

1Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, 2Division of Nephrology, The Hospital for Sick Children, Toronto, 3Department of General, Visceral & Transplant Surgery, University Medical Center Mainz, 4Department of Abdominal, Vascular & Transplant Surgery, Merheim Medical Center Cologne, 5Laboratory Medicine & Pathobiology, Toronto General Hospital, 6Departments of Surgery (Urology) & Physiology, The Hospital for Sick Children, Toronto, 7Developmental & Stem Cell Biology, The Hospital for Sick Children, Toronto

JoVE 52909


 Medicine

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

Detection of Microregional Hypoxia in Mouse Cerebral Cortex by Two-photon Imaging of Endogenous NADH Fluorescence

1Department of Microbiology and Immunology, University of Rochester Medical Center, 2Center for Neural Development and Disease, University of Rochester Medical Center, 3Deptartment of Neurology, Center for Neural Development and Disease, University of Rochester Medical Center

JoVE 3466


 Neuroscience

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