Upper arm Innervation

Parasympathetic Innervation

Humerus Fracture

These are the most common humeral fracture sites and their related injuries.

Rotator Cuff Muscles

 

Remember them with the mnemonic SITS (Supraspinatus, Infraspinatus, Teres Minor, Subscapularis).
Also remember the "Empty can supraspinatus test" used to evaluate this muscle asking the patient to abduct his/her arm to 90 degrees and flex the arm from that position 30 degrees (horizontally) with thumbs pointing to the floor, then apply downward force to his/her arms. This maneuver will elicit pain and weakness on the affected side due to impingement of the supraspinatus tendon (the most commonly affected structure in Rotator cuff Sd) between the acromion and the head of the humerus.

Nerves and Muscles responsible for abduction of the arm:

• Initiates arm abduction (initial 10 degrees) → Supraspinatus muscle <Suprascapular nerve>
• Abduct arm beyond 10 degrees → Deltoid muscle <Axillary nerve>
• Raise arm above horizontal → Serratus ant & Trapezius muscles <Long thoracic & Spinal acc nerves>

Trigeminal Nerve

Conjugate or Lateral Gaze

If the patient has a lesion on the right medial longitudinal fasciculus , upon asking the patient to look towards the left, only the left eye will go to the left while the right eye will be facing towards the examiner (front)

The Wrong Juice

Interesting case: ECG showing wide QRS complexes

That's why we have learned not to trust automatic ECG results...

Here is the script of what happened with this patient: (Source: Movin' Meat... Thanks to ER Dr Shadowfax...)

"The tech, as per protocol, dropped the ECG on my desk within three minutes of its being completed, along with the chart. He was visibly excited. I glanced at the ECG and the triage note. In the standard terse nursing verbiage, it read "CC: Ground Level Fall. Too weak to get out of bed. No injury reported. No other complaints." There was an included prior ECG, which was normal. Today's looked like this: (see ECG above)

"Should I call the cath lab?" the tech asked. We pride ourselves in having the best door-to-dilation time in the region, and it's a key focus of our department protocols that patients with an "Acute MI" or heart attack need to be expedited to the cath lab. The tech had seen the computer interpretation of "ACUTE MI" and was rarin' to go.

Colle's Fracture

Here another example of Colle's fracture.

Spinal cord

Source: neuroanatomyblog

Sensitive Pathways

Corticospinal tract (Motor Pathway)

Lithium Mechanism of Action (MOA)

1.       1^st Line Tx Bipolar Disorder

Works like Na+. Blocks Na Channels

-Cell can’t become too positive

-Cell can’t become too negative

Mood Stabilizer (not acute Dz)

Blocks Relapse & acute Maniac Events

2.       Blocks ADH receptors V2

→ Nephro DI

SIADH Tx

3.       Fools kidney: Holds Li, let go Na

→Hyponatremia

Affects Electrolytes & ion transport

4.       Fools Thyroid (Resembles I)

→Hyponatremia

5.       Fools PTH receptors:

a.       ↑Ca+2, ↓PO4

6.       Phospho Inositol Cascade Inhibition

Inhibits dephospholiration of IP3->IP2, IP2-IP1 and IP1-IP

(inositol recycling steps → ↓PIP2)

7.       ↓DA & NE turnover (↓DA ↓ NE ↑Serotonin)

(IP3 is recycled back to PIP2 by the enzymes inositol monophosphate phosphatase (IMPase) and inositol polyphosphatase phosphatase (IPPase); both of which are inhibited by lithium)

Restrictive lung Diseases

Explain all restrictive lung diseases.


Restrictive: interstitial problem (non-bacterial)

- Small stiff lungs (↓VC)

- Trouble breathing IN → FEV1/FVC >0.8

- ABG: ↓pO2 → ↑RR, ↓pCO2, ↑pH

- CXR: reticulo-nodular pattern, ground-glass appearance

- Die of cor pulmonale

- Ex: NM dz (breathing out is passive), drugs, autoimmune dz

- Tx: Pressure support on ventilator, ↑O2, ↑RR, ↑inspiratory time

Obstrucrive Lung Diseases

Obstructive: airway problem (bacterial)

• Big mucus-filled lungs (RV, Reid index = airway thickness/airway lumen)

•Trouble breathing out → FEV1/FVC < 0.8

• ABG: ↑pC02 → ↑RR, ↓pH

• Die of bronchiectasis

Ex: COPD

Tx: Manipulate rate on ventilator  ↑RR ↑expiratory time, ↑O2 only if needed.
 

Pulmonary Fibrosis

Source: Scientific Illustration

Von-Hippel-Lindau Syndrome

Dear Tsuzhi

We will miss you dear Tzuhsi. You brought us so much love & joy to our lives.... We will love you forever! @vs2020 pic.twitter.com/tyZ0yPnkBb

— quikev (@quikev) July 16, 2013

Seizure First Aid

Adrenergic Drugs

Brain Arteries

Brain (Vivi's notes)

 

Bandida

@robertojrvm @errodriguezc Encontré a una bandida coqueteándole al Mitsu... twitter.com/quikev/status/…

— quikev (@quikev) January 12, 2013