Instrumental delivery
Leroy C Edozien in The Labour Ward Handbook, 2010
F: The forceps blades are applied and checked. The posterior fontanelle should be located midway between the sides of the blades, with the lambdoid sutures equidistant from the blades and one finger-breadth above the plane of the shanks. A distance greater than this indicates that the head is extended; if the distance is less than one finger-breadth, this indicates that the head is over-flexed. The sagittal suture must be perpendicular to the plane of the shanks throughout its length; the fenestration of the blades should be barely felt, and the amount of fenestration felt on each side should be equal. If the blades have not been applied deeply enough, the palpable fenestration will be more than a fingertip and the operator is alerted to the risk of facial nerve injury.
Hydrocephalus
Prem Puri in Newborn Surgery, 2017
Bulging of the anterior fontanelle with a variably open posterior fontanelle, separation of the suture lines, and dilatation of superficial scalp veins (due to venous reflux from cerebral sinuses) are classical features of raised intracranial pressure in hydrocephalus. “Setting sun sign,” an upward gaze palsy, may be seen. This phenomenon consists of downward rotation of the eyeballs and retraction of the upper eyelids and may be accompanied by brow raising. Sixth-nerve palsy can occur due its sensitivity to pressure during its long intracranial course. Papilledema, decreased level of consciousness, and other focal neurological deficits can also be presenting signs. Opisthotonic posturing and bradycardic and apneic episodes are critical signs of raised intracranial pressure suggesting brain-stem compromise. This demands emergent neurosurgical assessment and treatment.
Paediatrics
Dave Maudgil, Anthony Watkinson in The Essential Guide to the New FRCR Part 2A and Radiology Boards, 2017
Are the following statements regarding ultrasound of the brain and spinal cord in a neonate true or false? It is commonly performed through the posterior fontanelle.Grade II intracranial haemorrhage implies ventricular dilatation.TORCH infections may cause subependymal cysts.At birth, the conus medullaris lies at the level of the L2/L3 vertebrae in 98% of cases.The central echo complex is a normal variant in the distal spinal cord.
Combination of a negative pressure suction device and endoscope can accurately locate the bleeding site of refractory epistaxis
Published in Acta Oto-Laryngologica, 2021
Xinghong Yin, Xinhai Zhang, Bo Wang, Keliang Li, Maoli Duan
Blood pressure, heart rate, electrocardiographic monitoring, and oxygen saturation were monitored in the local anesthesia operating room. With the patient supine, a conventional disinfectant towel was laid, nasal filler was removed, tetracaine and epinephrine cotton were used to anesthetize and contract the nasal cavity, and systemic examinations were performed under nasal endoscopy. The systematic search of the entire nasal cavity to detect bleeding was always performed in the same order: from anterior to posterior and from upper to lower, especially the following sites: junction of the nasal septum and nasal domain; nasal roof to the upper end of the nasal septum in the olfactory fissure area; junction of the middle nasal meatus and methyl plate of the middle turbinate (horizontal part and vertical part); upper margin of the inferior turbinate near the posterior fontanelle of maxillary sinus; front of the inferior meatus; posterior fornix of inferior meatus; and upper margin of the posterior nostril. Possible bleeding points were explored and, if none were found, the patients were randomly assigned to the negative pressure group (NPG) or control group (CG). For the CG, local selective tamponade was performed on suspected bleeding points during intraoperative exploration. In the NPG, the negative pressure device was applied, and negative pressure was adjusted to 40 kPa. The negative pressure football was placed into the anterior nostril of the affected side, and the patient was asked to press the other nasal alar with one hand to block the nasal cavity on the non-affected side and asked to hold their breath. The nasal cavity on the affected side connecting a negative pressure device form a closed space. then opening the negative pressure device, negative pressure in the nasal cavity is formed . Then, the bleeding site of the nasal cavity could be explored again under nasal endoscopy to accurately locate the bleeding site by following the blood flow at the time. Bleeding was stopped by electrocoagulation using an attractive haemostatic electrode, as shown in Figure 1. If nosebleed could not be induced, the patients underwent selective packing. The methodological protocol is illustrated in Figure 2.
Related Knowledge Centers
- Fontanelle
- Sagittal Suture
- Lambdoid Suture
- Lambda
- Hypothyroidism