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Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs.

Cardiac Exam II: Auscultation

JoVE 10124

Source: Suneel Dhand, MD, Attending Physician, Internal Medicine, Beth Israel Deaconess Medical Center

Proficiency in the use of a stethoscope to listen to heart sounds and the ability to differentiate between normal and abnormal heart sounds are essential skills for any physician. Correct placement of the stethoscope on the chest corresponds to the sound of cardiac valves closing. The heart has two main sounds: S1 and S2. The first heart sound (S1) occurs as the mitral and tricuspid valves (atrioventricular valves) close after blood enters the ventricles. This represents the start of systole. The second heart sound (S2) occurs when the aortic and pulmonary valves (semilunar valves) close after blood has left the ventricles to enter the systemic and pulmonary circulation systems at the end of systole. Traditionally, the sounds are known as a "lub-dub." Auscultation of the heart is performed using both diaphragm and bell parts of the stethoscope chest piece. The diaphragm is most commonly used and is best for high-frequency sounds (such as S1 and S2) and murmurs of mitral regurgitation and aortic stenosis. The diaphragm should be pressed firmly against the chest wall. The bell best transmits low-frequency sounds (such as S3 and S4) and the murmur of mitral stenosis. The bell should be applied


 Physical Examinations I

Blood Pressure Measurement

JoVE 10083

Source: Meghan Fashjian, ACNP-BC, Beth Israel Deaconess Medical Center, Boston MA

The term blood pressure (BP) describes lateral pressures produced by blood upon the vessel walls. BP is a vital sign obtained routinely in hospital and outpatient settings, and is one of the most common medical assessments performed around the world. It can be determined directly with the intra-arterial catheter or by indirect method, which is a non-invasive, safe, easily reproducible, and thus most used technique. One of the most important applications of BP measurements is the screening, diagnosis, and monitoring of hypertension, a condition that affects almost one third of the U.S. adult population and is one of the leading causes of the cardiovascular disease. BP can be measured automatically by oscillometry or manually by auscultation utilizing a sphygmomanometer, a device with an inflatable cuff to collapse the artery and a manometer to measure the pressure. Determination of the pulse-obliterating pressure by palpation is done prior to auscultation to give a rough estimate of the target systolic pressure. Next, the examiner places a stethoscope over the brachial artery of the patient, inflates the cuff above the expected systolic pressure, and then auscultates while deflating the cuff and o


 Physical Examinations I

Needle Thoracostomy

JoVE 10233

Source: Rachel Liu, BAO, MBBCh, Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA

A tension pneumothorax is a life-threatening situation in which excess air is introduced into the pleural space surrounding the lung, either through trauma to the chest cavity or as a spontaneous leak of air from the lung itself. Air trapped within the pleural space causes separation of the lung from the chest wall, disrupting normal breathing mechanisms. Pneumothorax may be small without conversion to tension, but when there is a significant and expanding amount of air trapped in the pleural cavity, the increasing pressure from this abnormal air causes the lung to shrink and collapse, leading to respiratory distress. This pressure also pushes the mediastinum (including the heart and great vessels) away from its central position, causing inability of blood to return to the heart and diminishing the cardiac output. Tension pneumothoraces cause chest pain, extreme shortness of breath, respiratory failure, hypoxia, tachycardia, and hypotension. They need to be relieved emergently when a patient is in extremis. Tension pneumothoraces are definitively managed by procedures that allow removal of trapped air, such as insertion of a chest tube. However, materials for chest tube placement are typically


 Emergency Medicine and Critical Care

Whole Organ Tissue Culture

JoVE 5799

Whole organs can be cultured ex vivo using specialized bioreactors, with the goal of repairing or replacing entire organs. This method uses a donor organ that is stripped of all cells, leaving behind the three-dimensional structure, and is then repopulated with new cells. This video demonstrates the whole organ culture of lungs, and shows how a dynamic culture that mimics the mechanical stimulation in the body is needed to induce native tissue properties.


 Bioengineering

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

Central Venous Access Device Dressing Change

JoVE 10311

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

Central venous access devices (CVAD), commonly known as central lines or central catheters, are large-bore intravenous (IV) catheters that are introduced into the central circulation. Typically, CVADs terminate in the superior vena cava, just outside of the right atrium of the heart, but they may also terminate in any one of the great veins (i.e., aorta, inferior vena cava, brachiocephalic vein, pulmonary artery, internal iliac vein, or common femoral vein). Patients may need a CVAD for any number of reasons. CVADs allow for the rapid infusion of fluids to treat significant hypovolemia or shock. They are also beneficial when administering vasoactive medications, highly concentrated medications, total parenteral nutrition (TPN), or chemotherapy, because the increased blood volume in these areas allows for the hemodilution of these potentially caustic or reactive agents. Patients who must receive multiple non-compatible IV medications, those that require long-term IV medications, or those with limited vascular access may also require the placement of a CVAD. These devices may be tunneled (i.e., inserted into a vein at one location and tunneled under the skin to emerge through the skin at another site)


 Nursing Skills

Shunt Surgery, Right Heart Catheterization, and Vascular Morphometry in a Rat Model for Flow-induced Pulmonary Arterial Hypertension

1Center for Congenital Heart Diseases, Department of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, 2Research and Development Facility, University Medical Center Groningen, University of Groningen

JoVE 55065


 Medicine

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

Normothermic Ex Situ Heart Perfusion in Working Mode: Assessment of Cardiac Function and Metabolism

1Department of Surgery, Faculty of Medicine, University of Alberta, 2Department of Pediatrics, Faculty of Medicine, University of Alberta, 3Department of Biomedical Engineering, Faculty of Medicine, University of Alberta, 4Department of Mechanical Engineering, Faculty of Engineering, University of Alberta, 5Department of Chemical and Materials Engineering, Faculty of Engineering, University of Alberta, 6Department of Physiology, Faculty of Medicine, University of Alberta, 7Canadian National Transplant Research Program

Video Coming Soon

JoVE 58430


 JoVE In-Press

Assessing Collagen and Elastin Pressure-dependent Microarchitectures in Live, Human Resistance Arteries by Label-free Fluorescence Microscopy

1Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, 2Department of Biochemistry and Molecular Biology, University of Southern Denmark, 3Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital

JoVE 57451


 Bioengineering

Sterile Tissue Harvest

JoVE 10298

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

In 1959 The 3 R's were introduced by W.M.S. Russell and R.L. Burch in their book The Principles of Humane Experimental Technique. The 3 R's are replacement, reduction, and refinement of the use of animals in research.1 The use of cell lines and tissue cultures that originated from research animals is a replacement technique, as it allows for many experiments to be conducted in vitro. Harvesting tissues and organs for use in cell and tissue cultures requires aseptic technique to avoid contamination of the tissues. Sterile harvest is also necessary for protein and RNA analysis and metabolic profiling of tissues. This manuscript will discuss the process of sterile organ harvest in rats and mice.


 Lab Animal Research

Biodegradable Magnesium Stent Treatment of Saccular Aneurysms in a Rat Model - Introduction of the Surgical Technique

1Department of Neurosurgery, Kantonsspital Aarau, 2Neuro Lab, Research Group for Experimental Neurosurgery and Neurocritical Care, Department of Intensive Care Medicine, University Hospital and University of Bern, 3Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau

JoVE 56359


 Neuroscience

Combined SPECT and CT Imaging to Visualize Cardiac Functionality

JoVE 10396

Source: Alycia G. Berman, James A. Schaber, and Craig J. Goergen, Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana

Here we will demonstrate the fundamentals of single-photon emission computed tomography/computed tomography (SPECT/CT) imaging using mice. The technique involves injecting a radionuclide into a mouse, imaging the animal after it is distributed throughout the body, and then reconstructing the produced images to create a volumetric dataset. This can provide information about anatomy, physiology, and metabolism to improve disease diagnosis and monitor its progression. In terms of collected data, SPECT/CT provides similar information as positron emission tomography (PET)/CT. However, the underlying principles of these two techniques are fundamentally different since PET requires the detection of two gamma photons, which are emitted in opposite directions. In contrast, SPECT imaging directly measures radiation via a gamma camera. As a result, SPECT imaging has lower spatial resolution than PET. However, it is also less expensive because the SPECT radioactive isotopes are more readily available. SPECT/CT imaging provides both noninvasive metabolic and anatomical information that can be useful for a wide variety of applications.


 Biomedical Engineering

Combined Near-infrared Fluorescent Imaging and Micro-computed Tomography for Directly Visualizing Cerebral Thromboemboli

1Molecular Imaging and Neurovascular Research Laboratory, Dongguk University College of Medicine, 2Biomedical Research Center, Korea Institute of Science and Technology, 3Research Institute of Advanced Materials, Department of Materials Science and Engineering, Seoul National University, 4Departments of Radiology and Cancer Systems Imaging, University of Texas M.D. Anderson Cancer Center

JoVE 54294


 Medicine

High-frequency High-resolution Echocardiography: First Evidence on Non-invasive Repeated Measure of Myocardial Strain, Contractility, and Mitral Regurgitation in the Ischemia-reperfused Murine Heart

1Department of Surgery, The Ohio State University, 2Heart and Lung Research Institute, The Ohio State University, 3Department of Cardiovascular Medicine, The Ohio State University

JoVE 1781


 Medicine

Instrumentation of Near-term Fetal Sheep for Multivariate Chronic Non-anesthetized Recordings

1Département de sciences cliniques, CHUV, Université de Montréal, St-Hyacinthe, QC, 2Département d'obstetriques et de gynécologie, CHU Ste-Justine Research Centre, Université de Montréal, 3Département de neurosciences, CHU Ste-Justine Centre de recherche, Université de Montréal, 4Centre de recherche en reproduction animale (CRRA), Université de Montréal, St-Hyacinthe, QC

JoVE 52581


 Developmental Biology

Compound Administration I

JoVE 10198

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

As many research protocols require that a substance be injected into an animal, the route of delivery and the amount of the substance must be accurately determined. There are several routes of administration available in the mouse and rat. Which route to use is determined by several factors of the substance to be injected: the pH of the solution, the volume required for the desired dosage, and the viscosity of the solution. Severe tissue damage can occur if a substance is administered incorrectly. This video looks at the various restraint methods and technical details for the most commonly used injection routes.


 Lab Animal Research

Generation of Human 3D Lung Tissue Cultures (3D-LTCs) for Disease Modeling

1Comprehensive Pneumology Center, Ludwig-Maximilians-Universität and Helmholtz Zentrum Munich, 2German Center of Lung Research (DZL), 3Translational Lung Research and CPC-M bioArchive, Helmholtz Zentrum München, Comprehensive Pneumology Center Munich DZL/CPC-M, 4Department of Experimental Medical Science, Lung Bioengineering and Regeneration, Lund University, 5Wallenberg Center for Molecular Medicine, Lund University, 6Stem Cell Centre, Lund University, 7Asklepios Fachkliniken Munich-Gauting, 8Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado

Video Coming Soon

JoVE 58437


 JoVE In-Press

Comprehensive Evaluation of the Effectiveness and Safety of Placenta-Targeted Drug Delivery Using Three Complementary Methods

1Laboratory for Reproductive Health, Institute of Biomedicine and Biotechnology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 2College of Veterinary Medicine, Hunan Agricultural University, 3Key Laboratory of Chemical Engineering Process and Technology for High-efficiency Conversion, College of Chemistry and Material Sciences, Heilongjiang University, 4Department of Obstetrics and Gynecology, Wayne State University School of Medicine

JoVE 58219


 Bioengineering

A Flow Cytometry-based Assay for Measuring Mitochondrial Membrane Potential in Cardiac Myocytes After Hypoxia/Reoxygenation

1State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 2State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College

JoVE 57725


 Behavior

Molecular Analysis of Endothelial-mesenchymal Transition Induced by Transforming Growth Factor-β Signaling

1David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, 2Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 3Hastings Center for Pulmonary Research, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Keck School of Medicine, University of Southern California, 4Department of Molecular Pathology, Graduate School of Medicine, The University of Tokyo

JoVE 57577


 Biology

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