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Cardiac conduction system and its relationship with ECG

The heart's conductions system controls the generation and propagation of electric signals or action potentials causing the hearts muscles to contract and the heart to pump blood.  
Nicole Chalmers
over 5 years ago
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18
1500

Conduction Pathway of the Heart

- This tutorial looks at the path by which the signal to contract is sent through the heart.  
youtube.com
over 3 years ago
29749
7
360

Cranial Nerve Examination - Abnormal

Cranial Nerve 1- Olfaction This patient has difficulty identifying the smells presented. Loss of smell is anosmia. The most common cause is a cold (as in this patient) or nasal allergies. Other causes include trauma or a meningioma affecting the olfactory tracts. Anosmia is also seen in Kallman syndrome because of agenesis of the olfactory bulbs. Cranial Nerve 2- Visual acuity This patientâs visual acuity is being tested with a Rosenbaum chart. First the left eye is tested, then the right eye. He is tested with his glasses on so this represents corrected visual acuity. He has 20/70 vision in the left eye and 20/40 in the right. His decreased visual acuity is from optic nerve damage. Cranial Nerve II- Visual field The patient's visual fields are being tested with gross confrontation. A right sided visual field deficit for both eyes is shown. This is a right hemianopia from a lesion behind the optic chiasm involving the left optic tract, radiation or striate cortex. Cranial Nerve II- Fundoscopy The first photograph is of a fundus showing papilledema. The findings of papilledema include 1. Loss of venous pulsation 2. Swelling of the optic nerve head so there is loss of the disc margin 3. Venous engorgement 4. Disc hyperemi 5. Loss of the physiologic cup an 6. Flame shaped hemorrhages. This photograph shows all the signs except the hemorrhages and loss of venous pulsations. The second photograph shows optic atrophy, which is pallor of the optic disc resulting form damage to the optic nerve from pressure, ischemia, or demyelination. Images Courtesy Dr. Kathleen Digre, University of Uta Cranial Nerves 2 & 3- Pupillary Light Refle The swinging flashlight test is used to show a relative afferent pupillary defect or a Marcus Gunn pupil of the left eye. The left eye has perceived less light stimulus (a defect in the sensory or afferent pathway) then the opposite eye so the pupil dilates with the same light stimulus that caused constriction when the normal eye was stimulated. Video Courtesy of Dr.Daniel Jacobson, Marshfield Clini and Dr. Kathleen Digre, University of Uta Cranial Nerves 3, 4 & 6- Inspection & Ocular Alignmen This patient with ocular myasthenia gravis has bilateral ptosis, left greater than right. There is also ocular misalignment because of weakness of the eye muscles especially of the left eye. Note the reflection of the light source doesn't fall on the same location of each eyeball. Video Courtesy of Dr.Daniel Jacobson, Marshfield Clini and Dr. Kathleen Digre, University of Uta Cranial Nerves 3, 4 & 6- Versions • The first patient shown has incomplete abduction of her left eye from a 6th nerve palsy. • The second patient has a left 3rd nerve palsy resulting in ptosis, dilated pupil, limited adduction, elevation, and depression of the left eye. Second Video Courtesy of Dr.Daniel Jacobson, Marshfield Clini and Dr. Kathleen Digre, University of Uta Cranial Nerves 3, 4 & 6- Duction Each eye is examined with the other covered (this is called ductions). The patient is unable to adduct either the left or the right eye. If you watch closely you can see nystagmus upon abduction of each eye. When both eyes are tested together (testing versions) you can see the bilateral adduction defect with nystagmus of the abducting eye. This is bilateral internuclear ophthalmoplegia often caused by a demyelinating lesion effecting the MLF bilaterally. The adduction defect occurs because there is disruption of the MLF (internuclear) connections between the abducens nucleus and the lower motor neurons in the oculomotor nucleus that innervate the medial rectus muscle. Saccades Smooth Pursui The patient shown has progressive supranuclear palsy. As part of this disease there is disruption of fixation by square wave jerks and impairment of smooth pursuit movements. Saccadic eye movements are also impaired. Although not shown in this video, vertical saccadic eye movements are usually the initial deficit in this disorder. Video Courtesy of Dr.Daniel Jacobson, Marshfield Clini and Dr. Kathleen Digre, University of Utah Optokinetic Nystagmu This patient has poor optokinetic nystagmus when the tape is moved to the right or left. The patient lacks the input from the parietal-occipital gaze centers to initiate smooth pursuit movements therefore her visual tracking of the objects on the tape is inconsistent and erratic. Patients who have a lesion of the parietal-occipital gaze center will have absent optokinetic nystagmus when the tape is moved toward the side of the lesion. Vestibulo-ocular refle The vestibulo-ocular reflex should be present in a comatose patient with intact brainstem function. This is called intact "Doll’s eyes" because in the old fashion dolls the eyes were weighted with lead so when the head was turned one way the eyes turned in the opposite direction. Absent "Doll’s eyes" or vestibulo-ocular reflex indicates brainstem dysfunction at the midbrain-pontine level. Vergenc Light-near dissociation occurs when the pupils don't react to light but constrict with convergence as part of the near reflex. This is what happens in the Argyll-Robertson pupil (usually seen with neurosyphilis) where there is a pretectal lesion affecting the retinomesencephalic afferents controlling the light reflex but sparing the occipitomesencephalic pathways for the near reflex. Video Courtesy of Dr.Daniel Jacobson, Marshfield Clini and Dr. Kathleen Digre, University of Uta Cranial Nerve 5- Sensor There is a sensory deficit for both light touch and pain on the left side of the face for all divisions of the 5th nerve. Note that the deficit is first recognized just to the left of the midline and not exactly at the midline. Patients with psychogenic sensory loss often identify the sensory change as beginning right at the midline. Cranial Nerves 5 & 7 - Corneal refle A patient with an absent corneal reflex either has a CN 5 sensory deficit or a CN 7 motor deficit. The corneal reflex is particularly helpful in assessing brainstem function in the unconscious patient. An absent corneal reflex in this setting would indicate brainstem dysfunction. Cranial Nerve 5- Motor • The first patient shown has weakness of the pterygoids and the jaw deviates towards the side of the weakness. • The second patient shown has a positive jaw jerk which indicates an upper motor lesion affecting the 5th cranial nerve. First Video Courtesy of Alejandro Stern, Stern Foundation Cranial Nerve 7- Motor • The first patient has weakness of all the muscles of facial expression on the right side of the face indicating a lesion of the facial nucleus or the peripheral 7th nerve. • The second patient has weakness of the lower half of his left face including the orbicularis oculi muscle but sparing the forehead. This is consistent with a central 7th or upper motor neuron lesion. Video Courtesy of Alejandro Stern, Stern Foundatio Cranial Nerve 7- Sensory, Tast The patient has difficulty correctly identifying taste on the right side of the tongue indicating a lesion of the sensory limb of the 7th nerve. Cranial Nerve 8- Auditory Acuity, Weber & Rinne Test This patient has decreased hearing acuity of the right ear. The Weber test lateralizes to the right ear and bone conduction is greater than air conduction on the right. He has a conductive hearing loss. Cranial Nerve 8- Vestibula Patients with vestibular disease typically complain of vertigo – the illusion of a spinning movement. Nystagmus is the principle finding in vestibular disease. It is horizontal and torsional with the slow phase of the nystagmus toward the abnormal side in peripheral vestibular nerve disease. Visual fixation can suppress the nystagmus. In central causes of vertigo (located in the brainstem) the nystagmus can be horizontal, upbeat, downbeat, or torsional and is not suppressed by visual fixation. Cranial Nerve 9 & 10- Moto When the patient says "ah" there is excessive nasal air escape. The palate elevates more on the left side and the uvula deviates toward the left side because the right side is weak. This patient has a deficit of the right 9th & 10th cranial nerves. Video Courtesy of Alejandro Stern, Stern Foundatio Cranial Nerve 9 & 10- Sensory and Motor: Gag Refle Using a tongue blade, the left side of the patient's palate is touched which results in a gag reflex with the left side of the palate elevating more then the right and the uvula deviating to the left consistent with a right CN 9 & 10 deficit. Video Courtesy of Alejandro Stern, Stern Foundation Cranial Nerve 11- Moto When the patient contracts the muscles of the neck the left sternocleidomastoid muscle is easily seen but the right is absent. Looking at the back of the patient, the left trapezius muscle is outlined and present but the right is atrophic and hard to identify. These findings indicate a lesion of the right 11th cranial nerve. Video Courtesy of Alejandro Stern, Stern Foundation Cranial Nerve 12- Moto Notice the atrophy and fasciculation of the right side of this patient's tongue. The tongue deviates to the right as well because of weakness of the right intrinsic tongue muscles. These findings are present because of a lesion of the right 12th cranial nerve.  
Neurologic Exam
over 8 years ago
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6
386

Cardiac conduction system and its relationship with ECG‬

The heart's conductions system controls the generation and propagation of electric signals or action potentials causing the hearts muscles to contract and th...  
YouTube
almost 5 years ago
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1
19

Hepatitis D

You can only contract this is you are also currently suffering from hepatitis B. You can get two types of infection: Normal co-existant infection – 90% of cases – this actually reduces the severity of the hep B infection! This is because infection with hepatitis D can reduce the replication rate of the hepatitis B virus. These people will usually make a full recovery from an unremarkable acute hepatitis.   
almostadoctor.com - free medical student revision notes
about 5 years ago
Www.bmj
1
16

Non-response bias versus response bias

Researchers used a postal questionnaire survey to investigate the career progression of NHS doctors. The questionnaire included details about past and current employment, future career plans, and when career milestones were reached. Analysis was confined to respondents working in the UK NHS (including those with an honorary NHS contract). The participants were all those who graduated from UK medical schools in 1977, 1988, and 1993. The questionnaire was sent to 10 344 graduates, of whom 7012 replied, giving a response rate of 68%.1  
bmj.com
about 5 years ago
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1
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Medical Student Podcast 003

Foundation Programme allocations (00:34), healthcare assistant university requirements (03:30), Ben Goldacre interview (07:08), student opinions on contract negotiations (13:38), #donatenominate (15:54)  
Audioboo
about 5 years ago
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1
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BMA - Home | British Medical Association

The British Medical Association (BMA) is the trade union and professional association for doctors and medical students in the UK. We negotiate doctors' contracts with the UK government and represent our members on the key issues that matter  
bma.org.uk
about 5 years ago
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1
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Medical Student Podcast 003

Foundation Programme allocations (00:34), healthcare assistant university requirements (03:30), Ben Goldacre interview (07:08), student opinions on contract negotiations (13:38), #donatenominate (15:54)  
audioBoom
over 4 years ago
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1
63

Untitled Document

The specialized nodal and conducting cells of the heart are responsible for heartbeat. These specialized nodal and conducting cells tend to contract weakly because they contain very few contractile cells (myofibrils). What makes these cells unique is that they can easily generate an action potential (electrical impulse that causes the heart to beat) without the assistance of neurotransmitters or any nervous system input like any regular neurons. Along with these special properties of self-excitability, these cells can also rapidly conduct impulses to atrial and ventricular muscles. This explains why after death, the heart continues pumping because of the nodal and conducting cells; this is because the nodal and conducting cells are not hooked up with any neurotransmitters. Therefore, these specialized cells provide a self-excitatory system for the heart to generate impulses and a transmission system for rapid conduction of impulses in the heart.  
odec.ca
over 4 years ago
Www.bmj
1
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Private firms enlisted to cut waiting lists for tests and surgery in £780m contract

Private firms have reached a deal potentially worth £780m (€1.1bn; $1.2bn) over four years to help NHS hospitals in England ease waiting times for surgery and diagnostic tests.  
bmj.com
over 4 years ago
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1
32

In brief

Recruitment agent is sentenced for faking locum doctors’ experience: Ross Etherson, 34, has been sentenced to two years in prison, suspended for 12 months, for enhancing the CVs of doctors without their knowledge while working at the London recruitment firm Midas Medical Recruitment. Seven locum doctors (mostly applying for senior house officer posts) were employed in Lincoln and Sussex hospitals on the basis of Etherson’s misleading documents. There was no evidence that patients suffered clinically as a result of the fraud, and hospitals released the doctors from their contracts where necessary.  
bmj.com
over 4 years ago
Www.bmj
1
14

“Human guinea pig” asks for animal studies

A trial participant whose request for animal data had been rejected turned to Peter Gøtzsche for help. It later emerged that the information he requested didn’t exist at the start of the human trial. He describes what happened and says the social contract between patients and corporate sponsors of drug trials is broken  
bmj.com
over 4 years ago
Www.bmj
1
20

In brief

Recruitment agent is sentenced for faking locum doctors’ experience: Ross Etherson, 34, has been sentenced to two years in prison, suspended for 12 months, for enhancing the CVs of doctors without their knowledge while working at the London recruitment firm Midas Medical Recruitment. Seven locum doctors (mostly applying for senior house officer posts) were employed in Lincoln and Sussex hospitals on the basis of Etherson’s misleading documents. There was no evidence that patients suffered clinically as a result of the fraud, and hospitals released the doctors from their contracts where necessary.  
bmj.com
over 4 years ago
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1
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T Mobile Customer Service Contact Number

T Mobile is one of the leading telecommunication providers in the United Kingdom. It together with EE and Orange covers more than 96 % of the population throughout the UK. T mobile is providing fast and efficient 3G network services to its millions of customers. The company is providing the best tariffs that can suit every customer’s needs. T mobile offers pay as you go plans and pay monthly contract to suit customer needs. For more details about T Mobile, you can call at T Mobile Contact Number given by us on this website.  
fixithere.net
almost 4 years ago
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1
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Why the new NHS junior doctors' contract is pushing me to Malta

Pay cuts and unsafe working hours are pushing our young doctors' loyalty to the NHS, and Britain, to its breaking point. I know I'm not alone  
telegraph.co.uk
over 3 years ago
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1
0

‘I can’t sacrifice my family for the NHS’: the junior doctors forced out of jobs they love

Young doctors are seething with anger over new contracts threatening lower pay, longer hours and increased stress. But do they really have it that bad? Here junior medics on the verge of quitting describe salaries that barely cover the bills – and a workload that means they could end up earning as little as £10 an hour  
theguardian.com
over 3 years ago
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1
1

Thousands Demonstrate Against The Government's New Junior Doctor Contract

Thousands of junior doctors marched on Downing Street on Monday night in protest against the government's new proposed contract, which would see young medics work longer hours and take a significant p  
huffingtonpost.co.uk
over 3 years ago
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1
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Save Our Contracts (live in parliament square) - filmed by Sear Productions

Here is a video of the an impromptu performance of Save Our Contracts at the Junior Doctors protest in London. Please help spread these videos over social me...  
youtube.com
over 3 years ago
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1
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Junior Doctors' Contract - The Issue

Junior doctors in the UK are facing the imposition of a new contract which will have major implications for them, for patients, and for the NHS. Watch this t...  
youtube.com
over 3 years ago