Show Advanced Search

REFINE YOUR SEARCH:

Containing Text
- - -
+
Filter by author or institution
GO
Filter by publication date
From:
October, 2006
Until:
Today
Filter by journal section

Filter by science education

 
 
Vital Signs: The signs of life that may be monitored or measured, namely pulse rate, respiratory rate, body temperature, and blood pressure.

Respiratory Exam I: Inspection and Palpation

JoVE 10028

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

Disorders of the respiratory system with a chief complaint of shortness of breath are among the most common reasons for both outpatient and inpatient evaluation. The most obvious visible clue to a respiratory problem will be whether the patient is displaying any signs of respiratory distress, such as fast respiratory rate and/or cyanosis. In a clinical situation, this will always require emergent attention and oxygen therapy. Unlike pathology in other body systems, many pulmonary disorders, including chronic obstructive pulmonary disease (COPD), asthma, and pneumonia, can be diagnosed by careful clinical examination alone. This starts with a comprehensive inspection and palpation. Keep in mind that in non-emergency situations the patient's complete history will have been taken already, gaining important insight into exposure histories (e.g., smoking), which could give rise to specific lung diseases. This history can then confirm physical findings as the examination is performed.


 Physical Examinations I

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

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

General Approach to the Physical Exam

JoVE 10043

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

The examination of the body is fundamental to the practice of medicine. Since the Roman Empire, physicians have described the connection between alterations in function of specific parts of the body and specific disease states and have sought to further scientific understanding to improve bedside diagnosis. However, in this modern age of increasing technology within medical diagnostics, it is important to consider the role that physical examination plays today. It is misguided to believe that physical examination holds all the answers, and much has been written about the questionable utility of certain maneuvers previously held in high regard. It is equally misguided to suggest that physical examination plays little role in the modern patient encounter. Physical examination remains a valuable diagnostic tool; there are many diagnoses that can only be made by physical examination. A diagnosis made by labs or imaging is rarely done in the absence of findings detectable at the bedside. As the provider conducts a history and physical, they are actively generating and testing hypotheses to explain the patient's condition. The information one gathers may not replace the need


 Physical Examinations I

Measuring Vital Signs

JoVE 10107

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

The vital signs are objective measurements of a patient's clinical status. There are five commonly accepted vital signs: blood pressure, heart rate, temperature, respiratory rate, and oxygen saturation. In many practices, pain is considered the sixth vital sign and should regularly be documented in the same location as the other vital signs. However, the pain scale is a subjective measurement and, therefore, has a different value according to each individual patient. The vital signs assessment includes estimation of heart rate, blood pressure (demonstrated in a separate video), respiratory rate, temperature, oxygen saturation, and the presence and severity of pain. The accepted ranges for vital signs are: heart rate (HR), 50-80 beats per minute (bpm); respiratory rate (RR), 14-20 bpm; oxygen saturation (SaO2), > 92%; and average oral temperature, ~98.6 °F (37 °C) (average rectal and tympanic temperatures are ~1° higher, and axillary temperature is ~1° lower compared to the average oral temperature). Vital signs serve as the first clue that something may be amiss with a patient, especially if the patient is unable to communicate. Although there are


 Physical Examinations I

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

Safety Precautions and Operating Procedures in an (A)BSL-4 Laboratory: 4. Medical Imaging Procedures

1Integrated Research Facility at Frederick, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH)

JoVE 53601


 Immunology and Infection

Intra-iliac Artery Injection for Efficient and Selective Modeling of Microscopic Bone Metastasis

1Lester and Sue Smith Breast Center, Baylor College of Medicine, 2Department of Molecular and Cellular Biology, Baylor College of Medicine, 3Graduate Program in Developmental Biology, Baylor College of Medicine, 4Department of Molecular and Human Genetics, Baylor College of Medicine, 5McNair Medical Institute, Baylor College of Medicine, 6Dan L. Duncan Cancer Center, Baylor College of Medicine

JoVE 53982


 Cancer Research

Initiating Maintenance IV Fluids

JoVE 10274

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

Hospitalized patients frequently require the administration of intravenous (IV) fluids to maintain their fluid and electrolyte balance. Certain medical conditions that preclude oral fluid intake may necessitate IV fluid administration, with or without electrolytes, to prevent hypovolemia, dehydration, and electrolyte imbalances. Pre-surgical and pre-procedure patients who require anesthesia are often required to be NPO (i.e., nil per os; Latin for "nothing by mouth") to prevent aspiration and to maintain hydration during the procedure. Post-surgical and post-procedure patients may also require IV fluid administration to increase intravascular volume following surgical blood loss. IV fluids can be delivered by different types of administrations sets: gravity flow infusion devices, which rely on gravitation force to push the fluid to the patient's bloodstream, or infusion pumps, which use a pump mechanism that generates positive pressure. While administering maintenance IV fluids using an infusion pump is the most common approach, facility policy; availability of infusion pump equipment; and other limitations, such as a power outage, may necessitate the use of IV gravity tub


 Nursing Skills

Repetitive Transcranial Magnetic Stimulation to the Unilateral Hemisphere of Rat Brain

1Department of Rehabilitation Medicine, Chungnam National University Hospital, Daejeon, 2Department of Biomedical Engineering, Seoul National University College of Medicine, 3Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, 4Department of Biomedical Engineering, Seoul National University Hospital, 5Department of Nuclear Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 6Department of Rehabilitation Medicine, Gangwon Do Rehabilitation Hospital, 7Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine

JoVE 54217


 Behavior

Using Multi-fluorinated Bile Acids and In Vivo Magnetic Resonance Imaging to Measure Bile Acid Transport

1Department of Surgery, University of Maryland School of Medicine, 2Department of Medicine, University of Maryland School of Medicine, 3Department of Radiology, University of Maryland School of Medicine, 4Food and Drug Administration, 5Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, 6VA Maryland Health Care System

JoVE 54597


 Medicine

Anesthesia Induction and Maintenance

JoVE 10263

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

The Guide for the Care and Use of Laboratory Animals ("The Guide") states that pain assessment and alleviation are integral components of the veterinary care of laboratory animals.1 The definition of anesthesia is the loss of feeling or sensation. It is a dynamic event involving changes in anesthetic depth with respect to an animal's metabolism, surgical stimulation, or variations in the external environment.


 Lab Animal Research

Considerations for Rodent Surgery

JoVE 10285

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

The Guide for the Care and Use of Laboratory Animals1 dictates that rodent survival surgery be performed aseptically. Aseptic technique utilizes specific practices that minimize the contamination of the surgical site, including patient preparation, surgeon preparation, sterilization of instruments and other supplies, and the use of a clean and controlled environment. Presurgical planning, intraoperative monitoring, and postoperative care are essential for successful recovery of animals from survival surgeries.


 Lab Animal Research

Tube Thoracostomy

JoVE 10283

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

Tube thoracostomy (chest tube placement) is a procedure during which a hollow tube is inserted into the thoracic cavity for drainage of fluid or air. Emergency chest tube insertion is performed for definitive treatment of tension pneumothorax, traumatic hemothorax, large-volume pleural effusions, and empyemas. Irrespective of the cause of air and fluid accumulation in the pleural space, the drainage relieves lung compression and enables lung re-expansion. In pneumothorax, air accumulation in the pleural cavity separates pleural layers, which prevents lung expansion during the respiration. Abnormal fluid accumulation, such as in case of hemothorax or empyema, causes separation of the visceral pleura that adheres to lung tissue from the parietal pleura that forms the lining of the chest cavity. The uncoupling of the pleural layers leads to disconnection of chest wall movement from the lung movement, causing respiratory distress. In addition, excessive pressure from overwhelming amounts of air or fluid in the pleura may push the mediastinum away from the central chest, causing inability of blood to return to the heart. In the trauma setting, a chest tube may


 Emergency Medicine and Critical Care

Pericardiocentesis

JoVE 10236

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

The heart lies within the pericardium, a relatively inelastic fibrous sac. The pericardium has some compliance to stretch when fluid is slowly introduced into the pericardial space. However, rapid accumulation overwhelms pericardial ability to accommodate extra fluid. Once a critical volume is reached, intrapericardial pressure increases dramatically, compressing the right ventricle and eventually impeding the volume that enters the left ventricle. When these chambers cannot fill in diastole, stroke volume and cardiac output are diminished, leading to cardiac tamponade, a life-threatening compression of the cardiac chambers by a pericardial effusion. Unless the pressure is relieved by aspiration of pericardial fluid (pericardiocentesis), cardiac arrest is imminent. Cardiac tamponadeis a critical emergency that can carry high morbidity and mortality. Patients may present in extremis, without much time to make the diagnosis and perform life-saving treatments. Causes of this condition are broken into traumatic and non-traumatic categories, with different treatment algorithms. Stab and gunshot wounds are the primary cause of traumatic tamponade, but it may occur from blunt trauma associated with


 Emergency Medicine and Critical Care

Assessing and Flushing a Peripheral Intravenous Line

JoVE 10265

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

After peripheral intravenous (IV) access is initiated, it is important to assess and maintain the IV catheter according to institutional policies and nursing standards of practice. The regular assessment of the insertion site and the surrounding areas for signs of complications is necessary to prevent IV catheter complications, including infiltration, phlebitis, infection, extravasation, or catheter dislodgement. Routine IV maintenance is equally important to preserve line patency and to reduce the risk of occlusion, thrombosis, and thrombophlebitis. According to the CDC, peripheral IV catheters (PIV) may be kept in place for as long as 96 h, with proper care and maintenance. In addition, according to the Infusion Nurses Society (INS), a pediatric patient IV catheter may be kept in place until the IV line is no longer patent or it demonstrates complications. Routine rotation every 96 h is not indicated in the pediatric population due to increased anxiety caused by needle sticks. This video demonstrates the assessment and maintenance of peripheral IV lines, including general considerations before initiating the procedure, assessing the injection site for associated complications, and ma


 Nursing Skills

Discontinuing Intravenous Fluids and a Peripheral Intravenous Line

JoVE 10278

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

Intravenous (IV) fluid administration and peripheral IV catheters (PIVs) may be discontinued for a number of reasons. The most common reason for discontinuing IV fluids is that the patient has returned to normal body fluid volume (euvolemia) and is able to maintain adequate oral fluid intake or is being discharged from the hospital. In addition, the Centers for Disease Control Guidelines for the Prevention of Intravascular Catheter-Related Infections (2011) recommends replacing PIVs every 72-96 h in adults to prevent the risk of infection or phlebitis. If the PIV becomes dislodged or if the insertion site demonstrates the signs and symptoms of infection, infiltration, extravasation, or phlebitis, the PIV should be discontinued and replaced. For pediatric patients, the Infusion Nurses Society recommends replacing the PIV only when the IV infusion site is no longer patent or when it demonstrates the signs and symptoms of complications. This video describes the approach to discontinue IV fluid administration and PIVs.


 Nursing Skills

Use of Two Intracorporeal Ventricular Assist Devices As a Total Artificial Heart

1Division of Cardiothoracic Surgery, Department of Surgery, Duke University, 2Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital and College of Medicine, 3Division of Surgical Sciences, Department of Surgery, Duke University

JoVE 55961


 Medicine

Magnetic-Activated Cell Sorting Strategies to Isolate and Purify Synovial Fluid-Derived Mesenchymal Stem Cells from a Rabbit Model

1Postgraduate institution, Guangzhou Medical University, 2Guangdong Provincial Research Center for Artificial Intelligence and Digital Orthopedic Technology, 3Shenzhen Key Laboratory of Tissue Engineering, Shenzhen Laboratory of Digital Orthopaedic Engineering, Shenzhen Second People's Hospital (The First Hospital Affiliated to Shenzhen University), 4Department of Chemistry, Chinese University of Hong Kong, 5Shenzhen Kangning Hospital, Shenzhen Mental Health Center

JoVE 57466


 Biology

Co-transplantation of Human Ovarian Tissue with Engineered Endothelial Cells: A Cell-based Strategy Combining Accelerated Perfusion with Direct Paracrine Delivery

1Center for Reproductive Medicine and Infertility, Weill Cornell Medical College, 2Angiocrine Biosciences, Inc., 3Tri-Institutional Stem Cell Derivation Laboratory, Weill Cornell Medical College, 4Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medical College

JoVE 57472


 Bioengineering

Imaging Cell Interaction in Tracheal Mucosa During Influenza Virus Infection Using Two-photon Intravital Microscopy

1Faculty of Biomedical Sciences, Institute for Research in Biomedicine, Università della Svizzera italiana (USI), 2Graduate School of Cellular and Molecular Sciences, Faculty of Medicine, University of Bern, 3Institute of Computational Science, Università della Svizzera italiana (USI)

JoVE 58355


 Immunology and Infection

12
More Results...