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Abnormalities of Second Stage
Published in Gowri Dorairajan, Management of Normal and High Risk Labour During Childbirth, 2022
If the posterior shoulder is high up or if the McRoberts manoeuvre fails to deliver the fetus, then we need to attempt to deliver the posterior arm (Figure 13.3b). The hand of the obstetrician corresponding to the ventrum of the fetus (left hand if the fetal back is on the left) is introduced till one reaches the cubital fossa. The hand should splint the humerus of the fetus by remaining parallel to the fetal arm, and no attempt should be made to give any tangential pressure on the arm. Gentle pressure on the cubital fossa will flex the elbow and allow grabbing of the hand. The hand is swept across the chest, and the posterior shoulder is delivered out by extending the arm. The delivery of the anterior shoulder follows automatically on gentle traction. If it fails, then the fetus must be rotated by 180 degrees to bring the anterior shoulder towards the sacrum and deliver it.
Upper Limb
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
The upper limb is divided into the shoulder, arm (between shoulder and elbow), forearm (between elbow and wrist) and hand. The axilla, cubital fossa and carpal tunnel are important areas of transition in the upper limb.
Cardiovascular system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
The thoracic aorta commences at the aortic valve and passes into the abdomen by passing through the diaphragmatic hiatus at the level of the T12 vertebral body. It is divided into the ascending aorta, aortic arch and descending aorta. Major vessels arise from the ascending aorta and arch. The right and left coronary arteries arise from the root of the ascending aorta close to the aortic valve cusps. The aortic arch gives rise to three large vessels that supply the head and neck region and the upper limbs: the brachiocephalic artery (also known as the brachiocephalic trunk or innominate artery), the left common carotid artery and the left subclavian artery. The brachiocephalic artery divides and give rise to the right common carotid and right subclavian arteries. Each common carotid artery divides into the internal and external carotid arteries. The vertebral artery arises as the first branch of the subclavian artery on each side. The subclavian artery passes laterally to continue as the axillary artery at the lateral border of the first rib. The axillary artery continues down the arm and at the inferior margin of the teres major muscle it becomes the brachial artery. At the cubital fossa the brachial artery divides into the radial and ulnar arteries, which continue down the forearm to the hand.
A red herring colonization of Mycobacterium lentiflavum in cutaneous sporotrichosis lesions misleading the diagnosis
Published in Baylor University Medical Center Proceedings, 2022
Thanita Thongtan, Jacob Nichols, Michelle Babb Tarbox
A 42-year-old man presented with a chronic wound on his right forearm for 1 month. He initially hit his right third digit on a tree root/branch in the swamps of Virginia while chopping a tree and sustained a contaminated laceration. Ten days later, his wound had a pimple-like nodule in the middle that later ulcerated with yellowish drainage. He went to a local clinic and underwent incision and drainage followed by a 10-day course of oral cephalexin. The patient returned to hunting the very next day, exposing his gauze-wrapped hand to a dirt pit. Over the next month, he developed multiple nontender nodules in an ascending fashion from his right wrist to the cubital fossa, subjective hardening of his blood vessels, along with swelling and aching pain of his right upper arm and axilla. He denied having fever or any other symptoms. He traveled across the United States with his dogs removing vermin (e.g., raccoon, fox, skunk, possum, and badgers) from traps or burrows and installing hardwood floors. He spent a lot of time in the woods, where he was exposed to swamps, lakes, dirt, and soil. He denied being bitten or scratched by animals.
Decreased baroreflex sensitivity is associated with cardiometabolic risks and prehypertension status in early-postmenopausal women
Published in Clinical and Experimental Hypertension, 2021
Soundirarajan Subhashri, Pravati Pal, Gopal Krushna Pal, Dasari Papa, Nivedita Nanda
Noninvasive continuous BPV with BRS was recorded using Finapres (Finometer version1.22a, Finapres Medical Systems BV, Amsterdam, The Netherlands) (32). This uses the principle of volume clamp method of Penaz and physical criteria of Wesseling, of the finger arterial pressure (20,33), and as described by us earlier (14,15). Reconstructed brachial artery pressure was calculated from finger arterial pressure. With the subject in supine position, the brachial cuff was tied around arm 2 cm above cubital fossa. The finger cuff was tied around the middle phalanx of middle finger. Height correction sensors were placed one at the level of heart and other at the level of finger, return to flow calibration and physiocal calibration were done. The BP recordings were obtained for 10 minutes and parameters were analyzed offline. The parameters recorded in BPV were heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, rate pressure product, inter beat interval, left ventricular ejection time, stroke volume, cardiac output, total peripheral resistance, and baroreflex sensitivity.
Intra- and intersession reliabilities of the flexor carpi radialis H-reflex while sitting with forearm pronation
Published in International Journal of Neuroscience, 2020
An electromyography unit (Cadwell Laboratories, Inc., Kennewick, WA, USA) was used to electrically elicit the FCR H-reflex. Data were collected at a sampling rate of 10 kHz, set at a gain from 500× to 2000× with a filter band pass of 10 Hz to 10 kHz. An Ag/AgCl surface stimulating bar electrode with coupling gel was placed at the distal third of the forearm. It was over and in line with the median nerve and was proximal to the cubital fossa (Figure 1). The active electrode was positioned proximal to the reference electrode to avoid anodal block [6]. The stimulating electrode delivered percutaneous electrical stimuli of 1.0 ms square-wave pulses at a frequency of 0.2 pps. The stimulation intensity for the H-maximum was maintained by verifying the constant amplitude of a minimal M-wave. An Ag/AgCl surface recording bar electrode with coupling gel was placed over the belly of the FCR to record the H-reflex amplitude and M-wave of the muscle, with the active electrode approximately over the FCR motor point and the reference electrode 2 cm lateral to it (Figure 1). A round metal ground electrode, 2 cm in diameter, was placed on the lateral aspect of the cubital fossa between the stimulating and recording electrode sites (Figure 1).