049 | Anatomy for the thoracic exam

Welcome back to the (very occasional) Anatomy for EM podcast.

I just gave a lecture at the excellent late summer school organised by the sono4you group. The course was in Graz in Austria but I was safely in my office at home unfortunately. The idea was to provide an anatomic refresher for those just starting to learn point of care ultrasound, in this case a group of super enthusiastic med students.

Thanks again for the invite and hopefully the lectures are somewhat informative.

Some of the images used in the talk were found via these great resources:

CoreUltrasound

The POCUS Atlas

Toronto TOE Simulator

048 | Anatomy for the cardiac exam

Welcome back to the (very occasional) Anatomy for EM podcast.

I just gave a lecture at the excellent late summer school organised by the sono4you group. The course was in Graz in Austria but I was safely in my office at home unfortunately. The idea was to provide an anatomic refresher for those just starting to learn point of care ultrasound, in this case a group of super enthusiastic med students.

Thanks again for the invite and hopefully the lectures are somewhat informative.

CoreUltrasound

The POCUS Atlas

Toronto TOE Simulator

047 | Anatomy for the FAST exam

Welcome back to the (very occasional) Anatomy for EM podcast.

I just gave a lecture at the excellent late summer school organised by the sono4you group. The course was in Graz in Austria but I was safely in my office at home unfortunately. The idea was to provide an anatomic refresher for those just starting to learn point of care ultrasound, in this case a group of super enthusiastic med students.

Thanks again for the invite and hopefully the lectures are somewhat informative.

CoreUltrasound

The POCUS Atlas

Toronto TOE Simulator

046 | Sensory Innervation of the Foot

Welcome back to the Anatomy for EM podcast. Today we cover the innervation of the foot through the lens of the ankle block.

So, yes this is another very much exam focused one. Ankle blocks are certainly handy but I always find that the foreign body is right on the overlapping border of all the territories and you end up having to block everything.

These days it might just be easier to an ultrasound guided sciatic and get everything you need but I digress…

• 5 Min Sono Popliteal
• Radiopaedia
• NYSORA
• Emory Ultrasound

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045 | Sensory Innervation of the Ear

I’m entering a few months prep for the UK and Ireland exit exam in Emergency Medicine: the FRCEM. I’ll be adding lots of little notes on pearls I’ve learned along the way. A lot of my revision is based around the Handbook of EM as a curriculum guide and review of contemporary, mainly UK guidelines. I also focus on the areas that I’m a bit sketchy on. With that in mind I hope they’re useful.

You can find more things on the FRCEM on this site here.

This one is special and has turned into an AFEM episode

This seems to be a favourite for examiners and not something i use commonly in real life

4 Nerves involved (the biggies in bold)

• auricolotemporal [V3]
• greater auricular [C2,3]
• auricular branch of [X]
• lesser occipital [C2]

Also note the names of the parts of the ear

The block (from the OHEM)

• Greater Auricular
  • 1cm below ear lobe all the way from post border of SCM to angle of mandible
• Lesser occipital
  • infiltrate just behind the ear
• Auriculotemporal
  • just anterior to the EAM and tragus (watching out for the superficial temporal artery

Here’s a video from EMRAP with a further somewhat simplified method

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044 | Sensory Innervation of the face Part 04 | Inferior Alveolar Nerve

We’re back for another series – this time focussing on the sensory innervation of the face through the lens of dental anaesthesia.

This is adapted from a take I gave in EuSEM 2016 in Vienna. This is part 3

The most important links you need are:

• Larry Mellick’s YouTube channel. This is incredible stuff and Prof Mellick was happy for me to use his videos
• NYSORA

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The AFEM podcast will always be free but feel free to donate to help cover hosting and the cost of web hosting and producing new episodes

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043 | Sensory Innervation of the face Part 03 | Infraorbital Nerve

We’re back for another series – this time focussing on the sensory innervation of the face through the lens of dental anaesthesia.

This is adapted from a take I gave in EuSEM 2016 in Vienna. This is part 3

The most important links you need are:

• Larry Mellick’s YouTube channel. This is incredible stuff and Prof Mellick was happy for me to use his videos
• NYSORA
• Radiopaedia Case

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The AFEM podcast will always be free but feel free to donate to help cover hosting and the cost of web hosting and producing new episodes

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042 | Sensory Innervation of the face Part 02 | Mental Nerve

We’re back for another series – this time focussing on the sensory innervation of the face through the lens of dental anaesthesia. This is part 2.

This is adapted from a take I gave in EuSEM 2016 in Vienna.

The most important links you need are:

• Larry Mellick’s YouTube channel. This is incredible stuff and Prof Mellick was happy for me to use his videos
• NYSORA

—

The AFEM podcast will always be free but feel free to donate to help cover hosting and the cost of web hosting and producing new episodes

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041 | Sensory Innervation of the face Part 01 | Trigeminal Nerve

We’re back for another series – this time focussing on the sensory innervation of the face through the lens of dental anaesthesia.

This is adapted from a take I gave in EuSEM 2016 in Vienna.

The most important links you need are:

• Larry Mellick’s YouTube channel. This is incredible stuff and Prof Mellick was happy for me to use his videos
• NYSORA
• Here’s a link to the slightly geeky article on facial and trigeminal cross overs.

 

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The AFEM podcast will always be free but feel free to donate to help cover hosting and the cost of web hosting and producing new episodes

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040 | Hand Part 08 | Blood supply and the thumb

Slides as PDF

This was the final podcast on the hand but we’ll be back again in a month or two with a series on dental problems and max fax bits and bobs. Thanks again for all the paypal donations. It really helps.

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039 | Hand Part 07 | The Muscles

Slides

with apologies to xkcd.com

The AFEM podcast will always be free but feel free to donate to help cover hosting and the cost of web hosting and producing new episodes

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038 | Hand Part 06 | The Nerve Supply

Welcome back for another podcast. This time it’s the turn of the nerve supply to the hand. In particular we’re covering the sensory supply. We’ll talk about motor supply when we discuss the intrinsic muscles of the hand.

Slides as PDF

Further Reading:

• Rosens 8th Chapter 50
• Roberts & Hedges 6th Chapter 31
• 5minsono.com on ultrasound guided blocks
  • Ulnar Nerve
  • Median Nerve
• Double-dorsal versus single-volar digital subcutaneous anaesthetic injection for finger injuries in the emergency department: A randomised controlled trial. PMID 26991958
  • RCEM FOAMed discussion on this paper
• Brian Lin demonstrating the transthecal technique

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037 | Hand Part 05 | The Flexor Tendons

This week it’s the flexor tendons. Certainly don’t hope to cover everything here but certainly a nice overview.

Slides as pdf

Some papers referenced in the podcast

• Rosens 8th Chapter 50
• Zafonte et al on pulley systems
• Lutsky et al on flexor tendon injury

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036 | Hand Part 04 | The Extensor Tendons

We’re slowing working our way proximally in the hand and this time we cover the extensor tendons.

The video

Slides as PDF

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Huge kudos to ALIEM who have some recent great posts on this that were released while i was prepping for the podcast. Thanks again to Michelle Lin for allowing their use.

• The Elson’s test by Michelle Lin (original paper here)

• Extensor Tendon Injuries
• Diagnosing the central slip

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035 | Hand Part 03 | The Fingers

 

Slides as PDF

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034 | The Hand Part 02 | The Fingertip

Onto the fingertip

Slides PDF

Further Reading

• LacerationRepair.com – great website by Brian Lin with great videos on all lacerations including nail bed injuries
• Nice review on Nail Bed injuries in Journal Hand Surgery: American

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033 | Hand Part 01 | The Lingo and the soft tissues

We’re back… after a few years hiatus (blame the children…) we have a series of podcasts on the hand. The hand needs some special anatomic attention for EM as we see so many injuries and their misdiagnosis and mismanagement has great potential for long term morbidity.

I’m not sure how many podcasts this series will stretch to but let’s get started.

Slides PDF

Further Reading

• Nice EMJ Review on soft tissue injuries

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The AFEM podcast will always be free but feel free to donate to help cover hosting and the cost of web hosting and producing new episodes

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032: Eye Anatomy Part 3

This is the third of a series of podcasts I’m doing on basic eye anatomy for the CEM FOAMed Network. This is a developing resource which aims to provide a fully mapped college curriculum with FOAMed resources. Be sure and check it out and get the podcast. This podcast went out a while ago on the CFN and I’m just providing it for everyone else who hasn’t got it already.

The single most important resource you need is Ophthobook.com

031: Eye Anatomy Part 2

This is the second of a series of podcasts I’m doing on basic eye anatomy for the CEM FOAMed Network. This is a developing resource which aims to provide a fully mapped college curriculum with FOAMed resources. Be sure and check it out and get the podcast. This podcast went out a while ago on the CFN and I’m just providing it for everyone else who hasn’t got it already.

The single most important resource you need is Ophthobook.com

030: Eye Anatomy Part 1

This is the first of a series of podcasts I’m doing on basic eye anatomy for the CEM FOAMed Network. This is a developing resource which aims to provide a fully mapped college curriculum with FOAMed resources. Be sure and check it out and get the podcast. This podcast went out a while ago on the CFN and I’m just providing it for everyone else who hasn’t got it already.

The single most important resource you need is Ophthobook.com

029: Critical Care Neuroanatomy SMACC Gold Talk

Back in March 2014 I had the pleasure of speaking at SMACC Gold in Australia. The whole thing was great fun and I’m sure you’re all aware it’s going to Chicago in May 2015 so be sure to be there. Indeed Registration opens tonight (in the UK at least) so check it out!!!

Every talk from the conference is coming out via the SMACC podcast so make sure you subscribe.

As my talk is so predominantly visual, it really needs the slides for it to make sense so I’ve included the slideset here and put the audio over the slides so you can get the feel of the talk.

SMACC 2014 presentation from Andrew Neill

For people interested in learning some more detailed neuroanatomy I’d strongly recommend headneckbrainspine.com

They’ve done what I’ve always wanted to do and have created scrolling, labelled radiology images that wonderfully demonstrate the anatomy in 3 dimensions. Really invaluable stuff.

Here’s a list of previous neuro related podcasts I’ve done:

• The C-Spine
• Vertebral Artery
• CSF Circulation
• Spinal Cord Injury
  • Part one
  • Part two
  • Part three
• Venous Sinuses
• Brain Herniation
• Internal Capsule
• Anterior and middle cerebral arteries
• Posterior Cerebral Artery
• Posterior Communicating Artery
• Cavernous Sinus

And if you’re interested in working where I work as an ultrasound or education fellow then get in touch.

028: Anatomy of the fasica iliaca block

Hi Guys, sorry for the big gap in posting. Life has a way of taking over as you all know.

I’m currently trying to introduce fascia iliaca blocks as part of routine care for patients in our department so i thought a podcast on some of the anatomy wouldn’t go a miss. If you want some light reading on the literature, then I’ve included a big list below. If you’re more practically orientated then I’d strongly recommend the following:

Ultrasound Podcast: Fem Nv Block

NYSORA: Fascia Iliaca Block.

Slides are on slideshare

References:

1.Godoy Monzón D, Vazquez J, Jauregui JR, Iserson KV. Pain treatment in post-traumatic hip fracture in the elderly: regional block vs. systemic non-steroidal analgesics. Int J Emerg Med. 2010;3(4):321–5.

2.Mouzopoulos G, Vasiliadis G, Lasanianos N, Nikolaras G, Morakis E, Kaminaris M. Fascia iliaca block prophylaxis for hip fracture patients at risk for delirium: a randomized placebo-controlled study. J Orthopaed Traumatol. 2009 Aug 19;10(3):127–33.

3.Høgh A, Dremstrup L, Jensen SS, Lindholt J. Fascia iliaca compartment block performed by junior registrars as a supplement to pre-operative analgesia for patients with hip fracture. Strat Traum Limb Recon. 2008 Sep 2;3(2):65–70.

4.Godoy Monzón D, Iserson KV, Vazquez JA. Single fascia iliaca compartment block for post-hip fracture pain relief. JEM. 2007 Apr;32(3):257–62.

5.NZ Guidelines Group. Acute Management and Immediate Rehabilitation After Hip
Fracture Amongst People Aged 65 Years and Over. 2003;:1–40.

6.National Clinical Guideline Centre. The management of hip fracture in adults. 2011;:1–664.

7.SIGN SIGN. Management of hip fracture in older people. 2009 Jun;:1–56.

8.(null) INHFDSG. Irish Hip Fracture Database Preliminary Report 2013. 2014 Mar 4;:1–50.

9.(null) TCOEM. Clinical Standards for Emergency Departments. 2013;:1–16.

10.Beaudoin FL, Haran JP, Liebmann O. A Comparison of Ultrasound-guided Three-in-one Femoral Nerve Block Versus Parenteral Opioids Alone for Analgesia in Emergency Department Patients With Hip Fractures: A Randomized Controlled Trial. Academic Emergency Medicine. 2013 Jun 12;20(6):584–91.

11.Elkhodair S, Mortazavi J, Chester A, Pereira M. Single fascia iliaca compartment block for pain relief in patients with fractured neck of femur in the emergency department: a pilot study. Eur J Emerg Med. 2011 Dec;18(6):340–3.

12.Williams R, Saha B. Best evidence topic report. Ultrasound placement of needle in three-in-one nerve block. Emergency Medicine Journal. 2006 May;23(5):401–3.

13.Christos SC, Chiampas G, Offman R, Rifenburg R. Ultrasound-guided three-in-one nerve block for femur fractures. West J Emerg Med. 2010 Sep;11(4):310–3.

14.Fletcher AK, Rigby AS, Heyes FLP. Three-in-one femoral nerve block as analgesia for fractured neck of femur in the emergency department: a randomized, controlled trial. Ann Emerg Med. 2003 Feb 1;41(2):227–33.

15.Beaudoin FL, Nagdev A, Merchant RC, Becker BM. Ultrasound-guided femoral nerve blocks in elderly patients with hip fractures. Am J Emerg Med. 2010 Jan;28(1):76–81.

16.Haines L, Dickman E, Ayvazyan S, Pearl M, Wu S, Rosenblum D, et al. Ultrasound-guided fascia iliaca compartment block for hip fractures in the emergency department. JEM. 2012 Oct;43(4):692–7.

17.Rashid A, Beswick E, Galitzine S, Fitton L. Regional analgesia in the emergency department for hip fractures: survey of current UK practice and its impact on services in a teaching hospital. Emergency Medicine Journal. 2013 Jul 22.

18.Abou-Setta AM, Beaupre LA, Rashiq S, Dryden DM, Hamm MP, Sadowski CA, et al. Comparative effectiveness of pain management interventions for hip fracture: a systematic review. Ann Intern Med. 2011 Aug 16;155(4):234–45.

19.Parker MJ, Griffiths R, Appadu BN. Nerve blocks (subcostal, lateral cutaneous, femoral, triple, psoas) for hip fractures. Cochrane Database Syst Rev. Wiley Online Library; 2002;1.

20.Foss NB, Kristensen BB, Bundgaard M, Bak M, Heiring C, Virkelyst C, et al. Fascia iliaca compartment blockade for acute pain control in hip fracture patients: a randomized, placebo-controlled trial. Anesthesiology. 2007 Apr;106(4):773–8.

027: Basic Anatomy of Abdomen and Pelvic Trauma

This is the second part of a recent lecture I gave to some first year med students to get across how important their anatomy is to understanding trauma.

First part lives here

 

I don’t expect anyone to pay for this but feel free to donate to help cover hosting and the cost of producing new episodes

[paypal-donation]

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026: Basic Anatomy of Chest Trauma

This is a screencast of a recent lecture I gave to some first year med students. It’s mainly to give the students some clinical info to keep their regular anatomy teaching relevant. It’s not designed to be a comprehensive intro to trauma in any way.

It’s longer than the usual podcasts so I’ve split into two parts.

Feedback, is as always, welcome.

I don’t expect anyone to pay for this but feel free to donate to help cover hosting and the cost of producing new episodes

[paypal-donation]

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025: PK SMACC talk

This one’s a little bit different. You’ve all heard of SMACC I’m sure. If not which rock where you hiding under?

It’s the the most exciting conference happening this year. All the your favourited FOAMites in one place giving it dixie on all things EM and Critical Care. There is still time to get booked in for it.

I, alas, will be holding fort on the Emerald Isle supporting the dog, wife and her ever enlarging bump and saving the spondoolies for next years SMACC (that’s happening lads isn’t it?)

They’ve put out the challenge for short, high impact teaching videos for the EM/CC community in the form of PK talks. Below is my offering. It’s a rehash of some old material but hope you like it.