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Anatomic Correlates of Physiologic Function

The respiratory and circulatory systems play a major role in the transportation of oxygen from the atmosphere to mitochondria and transportation of carbon dioxide from cells to the atmosphere. They accomplish these tasks by alternate steps of convection and diffusion. The respiratory system provides for the first two steps for oxygen, convection from the atmosphere and diffusion into the blood stream. Anatomic features are best understood…

The Development of Thoracic Anesthesia and Surgery

Introduction The history of anesthesia for thoracic surgery incorporates much of the history of anesthesia because contemporary thoracic anesthesia is a culmination of advances in all aspects of anesthesia. Knowledge and expertise with preoperative evaluation, airway management, intraoperative monitoring, pharmacologic agents, regional anesthesia, and intensive care management are all crucial for the thoracic anesthesiologist. Anesthesia for thoracic surgery encompasses over 100 years of advances in anesthesia…

Mai Huang: A 64-Year-Old Waitress With Left-Sided Abdominal Pain and Fever

Learning Objectives Learn the common causes of abdominal pain. Develop an understanding of the unique anatomy of the colon. Develop an understanding of the causes of diverticulitis. Develop an understanding of the differential diagnosis of diverticulitis. Learn the clinical presentation of diverticulitis. Learn how to examine the abdomen. Learn how to use physical examination to identify diverticulitis. Develop an understanding of the treatment options for diverticulitis.…

Vivian Zhao: A 32-Year-Old Female With Right Lower Quadrant Pain

Learning Objectives Learn the clinical presentation of appendicitis pain. Learn how to use physical examination to identify appendicitis. Develop an understanding of the treatment options for appendicitis. Learn the appropriate testing options to help diagnose appendicitis. Learn to identify red flags in patients who present with appendicitis pain. Vivian Zhao Vivian Zhao is a 32-year-old secretary with the chief complaint of, “My tummy hurts and I…

Brian Nguyen: A 23 Year-Old With Severe Testicular Pain and Hematuria

Learning Objectives Learn the common causes of testicular pain. Develop an understanding of the unique anatomy of the urinary tract. Develop an understanding of the sensory innervation of the urinary tract. Develop an understanding of the causes of pain associated with nephrolithiasis. Learn the clinical presentation of nephrolithiasis. Learn testing options to diagnosis nephrolithiasis. Learn how to use physical examination to diagnose nephrolithiasis. Develop an understanding…

Lydia Lutz: A 24-Year-Old Bartender With the Acute Onset of Severe Abdominal Pain That Radiates Through to Her Back

Learning Objectives Learn the common causes of abdominal pain. Develop an understanding of the unique anatomy of the pancreas. Develop an understanding of the causes of acute pancreatitis. Develop an understanding of the differential diagnosis of acute pancreatitis. Learn the clinical presentation of acute pancreatitis. Learn how to examine the abdomen. Learn how to use physical examination to identify acute pancreatitis. Learn how to use laboratory…

Chuck Connors: A 72-Year-Old Male With Persistent Pain Following a Thoracotomy for Lung Cancer

Learning Objectives Learn the common causes of pain following thoracic surgery. Develop an understanding of the anatomy and innervation of the chest wall and thorax. Develop an understanding of the unique relationship of the intercostal nerve to the rib. Develop an understanding of the causes of postthoracotomy pain. Develop an understanding of the differential diagnosis of postthoracotomy pain. Learn the clinical presentation of postthoracotomy pain. Learn…

Tommy “Tank” Teller: A 68-Year-Old Diabetic With Pain and Paresthesias Radiating Into the Lower Chest and Subcostal Area

Learning Objectives Learn the common causes of chest wall and subcostal pain. Learn the common causes of chest wall and subcostal numbness. Develop an understanding of the impact of diabetes on the peripheral nerves. Develop an understanding of the anatomy of the intercostal and subcostal nerves. Develop an understanding of the causes of peripheral neuropathy. Develop an understanding of the differential diagnosis of chest wall and…

Mike Zuckerburg: A 28-Year-Old Male With a Fever and Pleuritic Chest Pain of Acute Onset

Learning Objectives Learn the common causes of chest pain. Learn the common causes of hand deformity. Develop an understanding of the unique anatomy of the chest wall. Develop an understanding of the differential diagnosis of devil’s grip. Learn to identify the underlying diseases associated with devil’s grip. Learn the clinical presentation of devil’s grip. Learn how to examine the chest and chest wall. Learn how to…

Amy Cleaves: A 30-Year-Old Female With Shooting Chest Pain

Learning Objectives Learn the common causes of chest pain. Develop an understanding of the etiology of precordial catch syndrome. Learn the clinical presentation of precordial catch syndrome. Learn how to use physical examination to rule out pathology and other chest pain syndromes that may mimic precordial catch syndrome. Develop an understanding of the treatment options for precordial catch syndrome. Learn the appropriate testing options to help…

Laura McIlhenny: A 26-Year-Old Cosmetic Salesperson With Severe Knifelike Pain and a Clicking Sensation in the Lower Ribs Following a Seatbelt Injury

Learning Objectives Learn the common causes of chest wall pain. Develop an understanding of the innervation of the chest wall and pelvis. Develop an understanding of the anatomy of the chest wall. Develop an understanding of the causes of slipping rib syndrome. Learn the clinical presentation of slipping rib syndrome. Learn how to use physical examination to identify slipping rib syndrome. Develop an understanding of the…

Mark “Mo” Bandy: A 31-Year-Old Rodeo Rider With Broken Ribs After Being Thrown From a Bronco

Learning Objectives Learn the common causes of chest wall pain. Learn the common causes of fractured ribs. Develop an understanding of the anatomy of the ribs. Develop an understanding of the differential diagnosis of fractured ribs. Learn the clinical presentation of fractured ribs. Learn how to examine the lower extremity. Learn how to use physical examination to identify fractured ribs. Develop an understanding of the treatment…

Val Rider: A 29-Year-Old Female With Persistent Burning Rib Pain Following a Rib Fracture

Learning Objectives Learn the common causes of chest wall pain. Develop an understanding of the unique anatomy of the chest wall. Develop an understanding of the anatomy of the intercostal nerve. Develop an understanding of the causes of intercostal neuralgia. Develop an understanding of the differential diagnosis of intercostal neuralgia. Learn the clinical presentation of intercostal neuralgia. Learn how to examine the chest wall. Learn how…

Doug Montgomery: A 38-Year-Old Male With Anterior Chest Wall Pain Made Worse by Bending

Learning Objectives Learn the common causes of xiphodynia. Develop an understanding of the anatomy of the xiphoid. Develop an understanding of the differential diagnosis of xiphodynia. Learn the clinical presentation of xiphodynia. Learn how to examine the xiphoid process. Learn how to examine the xiphoid and xiphisternal joint. Learn how to use physical examination to identify xiphodynia. Develop an understanding of the treatment options for xiphodynia.…

Pete Wilder: A 23-Year-Old Printer With Persistent Chest Wall Pain Following CPR

Learning Objectives Learn the common causes of chest wall pain. Develop an understanding of the anatomy of the manubriosternal joint. Develop an understanding of the unique clinical presentation of manubriosternal joint pain. Develop an understanding of the differential diagnosis of chest wall pain. Learn how to use physical examination to identify the manubriosternal joint as the source of chest wall pain. Develop an understanding of the…

Thomas Wang: A 28-Year-Old Stockbroker With Severe Anterior Chest Pain

Learning Objectives Learn the common causes of chest wall pain. Develop an understanding of the unique anatomy of the chest wall. Develop an understanding of the causes of costosternal joint pain. Develop an understanding of joint injury. Learn the clinical presentation of costosternal syndrome. Learn how to use physical examination to identify pathology of the costosternal joint. Develop an understanding of the treatment options for costosternal…

Regional techniques during pregnancy and delivery

Key Points Neuraxial analgesia/anesthesia (spinal, epidural, combined spinal-epidural) are mainstays of safe anesthesia care of the obstetric patient. The anesthesia provider is caring for the mother, and by extension, the fetus. Hormonal and anatomic changes during pregnancy influence neuraxial technique and drug administration. Neuraxial analgesia (usually epidural or combined spinal-epidural) is the only analgesic technique that provides complete analgesia for labor and vaginal delivery. Neuraxial labor…

Paravertebral catheters in pediatrics

Key Points Performing this block requires ultrasound experience. Needle visualization plays a major role in achieving a successful block. Epidural spread can occur from a unilateral injection. Indications Patients who undergo operative procedures of the chest and upper abdomen. Unilateral coverage as thoracotomies, cholecystectomy, mastectomies, and other urological procedures with preservation of the pulmonary functions. Inadequate or unsuccessful epidural placement where bilateral catheters are placed. You’re…