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I purchased a neat little tool that allows me to use my iPhone 6s to take videos and photographs of the external surface of the eye.
Paracentesis, or a peritoneal tap, is a procedure emergency physicians often perform to obtain ascitic fluid for diagnostic or therapeutic purposes. I recently spent a week in Jamaica as part of a medical and dental team providing care under relatively harsh conditions.
This video was made in a medically austere environment during which we were plagued by flies and other insects, but it demonstrates nicely the equipment and procedural steps of a dental extraction. Obviously, the patient who presents with calf pain requires careful consideration for a deep vein thrombosis.
Palpation should occur along the entire length of the muscles and the aponeuroses to identify tenderness, swelling, thickening, defects, and masses, if present.
Taking advantage of the different anatomical origins for the gastrocnemius and soleus muscles allows the examiner to isolate the activation of the muscles by varying the degree of knee flexion. The second video demonstrates the Thompson test, which assesses for complete disruption of the Achilles tendon. Neither the service provider nor the domain owner maintain any relationship with the advertisers.
I am still learning how to maximize the photographs and videos, but the clinical and educational possibilities are really exciting.
Catheter aspiration of fluid is performed to determine the etiology in new onset ascites, to look for infection or presence of cancer, or simply to relieve pressure from a painful, distended abdomen that sometimes can interfere with breathing. In fact, I often allow the ophthalmology service to take the lead with eyelid injuries and plastic surgery to manage severely lacerated ears. My video this month, however, would suggest that pulling teeth may actually not be all that tough.
The layout of our makeshift clinics allowed me to work alongside a dentist and two dental assistants.
But when the history doesn’t fit, you may find yourself scratching your head trying to figure out the other sources of calf pain. The aponeuroses of the gastrocnemius, soleus, and plantaris unite to form the Achilles or calcaneal tendon. Gastrocnemius strains typically present with tenderness in the medial belly or the musculotendinous junction. In case of trademark issues please contact the domain owner directly (contact information can be found in whois). The Eidolon Photo Bluminator has the potential to take excellent still photographs and high-quality videos of the external surface of the eye.This tool allows photo filters that have blue LED light for fluorescein photos of the cornea or white LED illumination for photos of the anterior segment.
Contraindications to the procedure might include an acute abdomen, severe thrombocytopenia, or a coagulopathy. Not only are the repair of these unique skin-over-cartilage structures at risk of serious complications, they are also potentially time-consuming.Ear cartilage is completely dependent on the overlying skin for survival and has unique risks for infection.

Besides getting the opportunity to pull my first permanent tooth, I was able to enlist the dental team’s collaboration on a teaching video, in which we demonstrate the elemental steps of pulling a tooth. Sure, you can just pick your favorite ICD-10 diagnosis for right or left calf strain, write a prescription for ibuprofen, give some crutches, and send the patient out the door.
The pain is often lateral with soleus strains, but the painful soleus is also activated when the posterior calf is palpated. When the knee is in maximal flexion, the soleus becomes the primary force generator in plantar flexion. If the soleus contributions to the calcaneal (Achilles) tendon remains intact, it is possible to have some residual plantar flexion movement when the calf is squeezed by the examiner. Relative contraindications include pregnancy, a distended urinary bladder, abdominal wall cellulitis, adhesions, or distended bowel.Our video this month is one of the best step-by-step presentations you will ever find for safely performing this procedure. Perichondritis is a feared complication that is sometimes resistant to treatment and can result in disfiguring complications.This video allows us to review the basic principles of ear cartilage laceration repair. You won’t find the plantaris muscle in six to eight percent of the population, but that is not a big deal because the plantaris is considered largely vestigial and rarely involved in calf strains. The video shows how to isolate the soleus by alternately tightening and relaxing the gastrocnemius muscles and palpating for the tender soleus muscle.
The lens provides 7.5 times magnification, and is designed specifically for ophthalmic use. Richard Gordon, MD, expertly shows how to use an ultrasound to window-shop for the best location to insert the peritoneal catheter. The truth is that this repair doesn't need to be daunting if you systematically addresses the unique needs of the injured ear:Cartilage needs to be covered with skin. Why not take the two additional minutes required to sort out exactly the source of the calf pain? The other muscles of the triceps surae, the gastrocnemius and soleus muscles, however, are vulnerable to injury.
Concomitant tears of the soleus and gastrocnemius do occur, but thankfully are much less common. When the knee is flexed and pain is elicited with plantar flexion of the foot, in other words, one can be pretty confident that the soleus muscle has been injured.
The cartilage has no other source of blood supply, oxygen, and nutrients without the overlying skin tightly adhering to it.
This blog post provides several pearls for a more sophisticated (and rewarding) examination of the calf muscles, the triceps surae. The gastrocnemius muscle especially so because it crosses two joints and has a high density of type two fast-twitch muscle fibers.
Consequently, you do everything possible to make sure the skin and cartilage are married up tightly. The soleus muscle is sometimes injured in isolation, so differentiating strains of the gastrocnemius or soleus muscles is important for treatment and diagnosis.

I work in a teaching hospital and ophthalmology residents are immediately available, so sending videos are probably not a major asset to me. In fact, experts recommend that you trim away and sacrifice the excess cartilage if skin is missing.Cartilage is relatively fragile and vulnerable to tearing during suturing. A combination of palpation, strength testing, and stretching is required to localize injuries to the gastrocnemius or soleus. Consider the value of this tool, however, in the hands of an emergency medicine health care provider working in a rural emergency department and the added ability of explaining his findings with actual pictures or videos for the consulting ophthalmologist. Cartilage is fragile, and its saving grace is the tough perichondrium layers on its service. This little tool is the answer from a clinical teacher's perspective.Like most digitally magnified pictures on the iPhone, the image becomes slightly grainier when enlarged, so I don't do that. Experts recommend sutures be placed simultaneously through the skin and perichondrium rather than the full-thickness of the cartilage.
The company actually recommends that the iPhone zoom be set at a middle-magnification setting for still photos unless the entire orbit is of interest. Not only does this ensure a tight adherent relationship between the skin and cartilage, it avoids absorbable sutures buried under the skin.
One can select the 1080p video at 60 fps instead of 30 fps, however, for the iPhone video option. The associated unavoidable inflammatory reactions of buried sutures can leave residual lumpy defects in the cartilage under the skin.
Basically, the perichondrial sutures should be the deepest layer of closure.The cosmetic outcome is benefitted by your sequence of suturing. Starting to suture on the posterior aspect of the lacerated ear sets the stage for a more successful outcome on the cosmetically — more importantly, externally — exposed ear. You need to suture the anterior and lateral surfaces last.Effective packing of the finished repair may also be important. You can hold down the shutter icon on the screen or on either of the volume buttons to start a rapid burst of pictures for patients whose eyes are moving or blinking, and you can then select the best one. Experts feel auricular hematomas are uncommon in simple auricular laceration repair, and some recommend against wound compression that could cause vascular compromise and poor healing.
Clicking the actual picture brings up the select option, and pressing select will put a gray circle under the best photo. The downside of using the HDR setting is that it increases the chance of blurring.Besides the grainer pictures with the higher digital magnification, I have found the actual defect on the corneal surface may on occasion be surprisingly not-so-obvious with a head-on view of the curved surface of the eye.

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