This stage is simply the diameter of the baby’s head into the mother’s pelvic cavity from ear to ear. The movements where the baby shifts themselves into position are known as the seven cardinal movements. In order to position correctly, a baby in the womb will try it’s best to shift into a direction that best facilitates birth. Management: Penetrating cardiac trauma require emergent thoracotomy, pericardial window.A baby’s position is important for birth to proceed naturally, allowing the smallest part of the baby to present first. Hemodynamically unstable patients require immediate operative therapy after quick bedside assessment (physical exam, ultrasound, chest tube as needed)ĭifferential Diagnosis: Bronchial injury, Diaphragm injury, Hemothorax, Tension Pneumothorax, Aortic Transection, Esophageal injury, PneumomediastinumĮvaluation: Ultrasound (FAST Exam), CXR, CTA in stable patients, ECG, troponin.Cardiac Tamponade more common from stab wounds than from gun shot wounds.Conduct FAST exam to examine for cardiac tamponade, hemothorax, pneumothorax.Beck’s Triad: Hypotension, JVD, muffled heart sounds may not be present initially.Order of injury: Right Ventricle -> Left Ventricle -> Right Atrium -> Left Atrium. Cardiac Box: Surrounded by sternal notch, xiphoid process and nipples.Evaluate for tension pneumothorax or cardiac tamponade in all patients presenting with chest trauma and shock.Initial Assessment of ABC, ATLS primary survey guidelines.A suggested method to prevent this kind of injury is to perform bladder aspiration to insure balloon positioning prior to inflation. Inflating a balloon in the ureter might result in severe ureteric injury. abnormal ureteric insertion site) might put the patient at a higher risk for it. However, it is thought that the presence of an underlying anatomical deformity (e.g. There are no clear predisposing factors to this complication. Ureteric insertion of foley catheters is a very rare complication of foley catheterization. Gallbladder distension ( >5 cm width, >8 cm length).Ģ- An inflated foley catheter in the ureter! Things to look for on an abdominal CT that are suggestive of cholecysitis: The absence of cholecysitis on CT will help the argument against the diagnosis, but if the suspicion is high an ultrasound study should still be obtained. CT has a negative predictive value of 89%, compared to 97% to that of ultrasound. The negative predictive value of CT is still relatively high. However, CT scans can still be obtained for non-classic presentations. Ultrasound remains the best modality to test for cholecystitis. How to do an intra-oral US-guided needle aspiration of PTA, check out:įor a brief video on how to perform a transcutaneous US for PTA:
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