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Mnemonics in Medicine

Dec 28 | 3:30 PM

The body of medical knowledge is constantly evolving rapidly, with recent additions to symptomatology, management procedures, therapeutics, prescription names, and so much more. Dr. Mahadev Desai, a highly-experienced clinician, has perfected the art of remembering the latest updates in medicine through mnemonics. Join us for a fun-filled feast to enhance your memory and keep up with the cutting-edge changes in the medical world! You can submit your favorite once to us and we'll pick the best replies for discussion during the session and for our forthcoming Medflix blog! Link: https://pxmd.co/mnemo

[Music] hello everyone i dr rucha welcome you all to this sumptuous fist on mnemonics a very interesting session very basic one and the one which we actually start right from our bdc textbooks so uh we have dr mahadev who is a senior consultant physician from ambad and sir has kindly agreed to walk us through some practical and practical mnemonics which will be definitely useful during the practice i'm sure and uh we had actually learned uh actually gone through uh just give me a second so we had actually run a campaign where we actually invited everyone to submit their own mnemonics because i'm sure every one of us have their own set favored one basic ones actually from an ad to medicine so uh you could actually submit via those forms and we have three winners here but if you really want to again uh participate in this and want to uh submit your mnemonics we'll call your names uh in the end of the session and we can definitely discuss at that time later so with this i'll stop this and i'll hand it over to you yeah good evening everyone and welcome to this special episode of netflix where we are going to discuss a little unusual topic of mnemonics in general and medicine though it was widely publicized as mnemonics and medicine i thought that first i will talk something about the basics of mnemonics itself and then we go ahead with the mnemonics in medicine it's a very vast topic and there is no end to it there is it's a totally both side opened a subject so you can start anywhere you can stop anywhere and you can interrupt me but i would wish that we'll take your mnemonics only after i finish whatever i have to say and mnemonics are in use for a long time but the very short version of mnemonics i have suddenly come up after whatsapp and you can see all these on your left side whether it's in aka or fy i or atm or gsk and all that we use it day in doubt to for the mainly for the time part of it but we have been using in our college this right from as you can see uh one of the slides right and that probably everyone would say that this is one you would always remember and but for the mnemonics probably you would not easily remember all the colors of the rainbow that's webgr right you know so we begin with the disclaimer that i am grateful to multiple sources of informations including various websites very mnemonics and pictures that i have gathered from multiple sources and i'm indeed grateful and thankful to all the creators and owners and let me tell you i do not own one any one of them but definitely we have arranged in such a way that it makes a flow and at the end of the day at least you'll remember few of the tips and you will be easy to remember by way of mnemonics so what is mnemonic mnemonic is a art of memorizing we know that memory is something that we are always annoying of somebody else's right when it comes to our own people that we don't remember memory is what what is memory memory is a process of recollecting an information storing it and retiring as and when it is required so if there is some art which one can easily retrieve the memory probably you are better off and if you remember these are the very first days of our school days when we remember in the form of knuckle mnemonics right when it comes to the number of days in a month we would always show this right so we begin with this i'm sure and i will end with this so in between with there will be almost 20 mnemonics that you have to learn right so when mnemonics can be in the form of written words it can be for figures gestures musical type of mnemonics but what is mnemonics why did the word mnemonic come from that's also interesting story you said no right the word navoni come from the greek mythology and in greek mythology mnemonics is meaning of memory or related to memory right and in greek mythology nemo sign is the goddess of memory uh she was the daughter of uranus heaven and gia earth and she gave birth to nine muses right so she was very beautiful she had all the powers of not only memory but all people who are dead were made alive and all their memories were restored that is what the mythology goes so mnemonics can be in the form of written words where we use different words for the mnemonics also as we'll see later on it can be in the form of an acronym or abbreviation these two words are very interchangeable they have different set of rules for that then a part of acronym is called an acronym and there is also a slow acronym we'll see all one by one right so what is acronym acronym is a word or a name formed from the initial components of a longer name or phrase right the most common way of doing it is a capitalization scheme that means you select one word from a the whole sentence you pluck one word right and give one capital letter and then make one word that becomes an acronym like the individual initial letters are taken in the commonly known acronym acronyms like who vip scuba i am sure very few people will know that scuba is not a word it's an acronym and it's acronym for something that we'll see in the next slides so it can be in initial lectures are individualized or there may be two syllables taken from each one of them and that becomes a benelux and then it could be a mixture of the letters and the words right syllables that is a mixture of the two so what is scuba anybody i don't think we have time for that so scuba becomes a acronym for self-contained underwater breathing apparatus self-contained underwater breathing apparatus benelux is the syllables belgium netherland and luxembourg and radar is nothing but a radio detection and raging but we all been using scuba radar as if they are the word themselves right yes the acronyms can be pronounced either as the word like nasa scuba unesco or it can be what as it can be pronounced as individual letters like cbi atm or jsk right then comes to abbreviation what is abbreviation abbreviation is in any type of certain form right maybe you omit middle words maybe you stop there or truncate the latter words or may use three capital letters for three different names or maybe you use different kinds of combinations words with middle names omitted is our profession we write dr for doctor and we write rd for row so you can do this kind of shortcuts that is called the abbreviation then if the n words are truncated that's like professor prof professor then 3m you know originally 3m was the company wall minister mining and manufacturing company and k3g and there are so many short forms for the different kinds of hollywood's movie you know kapikosika become and all then what is an acronym we already talked about scuba laser radar these are the actual acron uh and acronyms but they are used as words uh in a common usage and that is why they are called anachronists and the last part of it is a pseudo acronym this is particularly few words are selected in such a way that if you expand it it doesn't make any sense of it right say barbecue you write bbq but bbq is not the if you expand it it doesn't become barbecue right but some smart people have come out with bbq as a acronym for better be quick bbq well that's about the introduction part now we go to the mnemonics and medicine and we have selected few important mnemonics just to highlight that how we memorize and we can make our own mnemonics there is nothing wrong in it and that's if you remember it that way the idea is to just recall the way we want it so we have selected for you from anatomy and physiology few from emergency medicines free from kidney and genitory tract then neurology hematology and infectious disease we all know at least those who are in the medicine and the surgery and the super specific branches that same so many of our trials clinical trials and scientific studies are all starting with the either acronyms or abbreviations right like whether it's in ukps or whatever you want it right so we begin with the first and foremost practically when we ask for the mnemonics majority have come out with one and that is this that is the remembering the carpal bones carbal bones are the ones which are at the wrist joint and it's otherwise but for this probably would not be able to remember it so the mnemonic goes she looks too pretty try to catch her where each first syllable of a word becomes the name of the small bone that is the part of the carpal bone so starting from the proximal row and then the digital row and starting from the thumb side to the ulnar side or the lateral to medial side we call it so i am not sure how many of can recall recollect the actual names of the small bones so this is c4 scaphoid looks for unit two for triquetrium then pretty for pc form try for trapezium another two for the trapezoid then c for capit or catch for capet and her for hemet so it's a scaphoid lunate aquatium pc from trapezium trapezoid capacitan hemet these are the small bones of the carpal then again another formula like chemical formula like lr6 so4 r3 and they stand for the extracurricular muscles innervations we know lr6 stands for the lateral axis is also innervated by the sixth now then the superior oblique is innervated by the fourth now and rest of the extracurricular muscles are uh innervated by the third now or the accumulator now so lr6 lateral rectus sixth kernel now superior oblique fourth cranial now and rest of the muscles by the third rule now so it becomes so easy to remember that's the idea of getting the mnemonics then rotator cuff tendons sits we know it's very difficult to remember many muscles which are around the solder curdle now this one is easy one to remember the rotator cuff in practice we see so many patients with the rotator cuff injuries especially in the diabetes we have got the periarthritis then seed stands for the supraspinatus infraspinatus teres minor and sub capillaries of physiology we used to have very difficult in remembering the three layers of the adrenal cortex and the hormones they are released by them so sonar glomerulus are from outwards to inverse sonogram relations stands for gfr mineralocorticoids glucocorticoids and androgens then we go to the emergency mnemonics emergency mnemonics are very very important because we have to recollect and act in time so this particular pneumonia is the publicized by the american neurological societies and they want the stroke to be identified as early as possible because now they advocate that stroke is one kind of brain attack if we put a word attack then only the common people would see the sense of urgency so initially it came out as a fast and they added then two more letters that is b fast so each letter there is one particular action or the neurological deficit that can identify a stroke in time because of the advent of the thermolytic therapy that if we spot stroke in time and especially here can pick up in the golden hour that is the first three hours then we can definitely have a very meaningful recovery of the stroke otherwise we know stroke has a very big disability to follow so what stands for b fast b is for the balance either the patients may get vertigo or dizziness or the imbalance atexia then e for the blurring of the visions or diplopia f for the facial asymmetry there may be drilling of the salary from one side or the asymmetry of the face and a is for the arm weakness or the leg weakness then speech is the slurring of the speech or absence of the speech and then is the time to call 108 in our country 911 usa so spot a stroke by be fast by balance by eyes eyes symptoms or facial asymmetry or arm or leg weakness or the speech disturbances and it's time to act this one definitely it can be put to practice from tomorrow itself and that is the maintenance of the intervenous fluids now we have to calculate for each individual patients how much fluid we should give as a maintenance prior and whether it's an adult or child if you remember four to carbon you remember four two carbon one two four from anil kapoor's movie ram lakshman so he is here 4 ml per kg for our for the first 10 kg for the first 10 kg of the weight you assign 4 then for the next 10 kg is 2 ml and for the remaining each one is a 1 ml and maximum is 100 ml per hour that is how the maintenance fluid should be calculated so if the adolescent boy is having a 37 kg weight then for the first 10 kg it would be 40 ml then for the next 10 kg to return 10 into 2 is 20 ml and for the remaining 17 out of the 37 kg it would be 17 ml so total uh you would require 77 ml per kg so the 100 ml per kg comes for the 60 kg weight any person who is more than 60 kg you can straight away give 100 ml per hour this is for the maintenance fluids if the patient is in shock and you might need to give much more that different disease only for the maintenance iv fluids remember four to carbon next is ios ml equations are the types of hypersensitivity the types of hyperside reaction we know they are type 1 type 2 type 3 and type 4 they are divided based on the duration of the actions and the mechanism of the action for mechanism involved for the hypersensitivity we know type 1 is anaphylaxis type 2 is cytotoxic type 3 is the immune mediated and type d is a direct kind of hypersensitive reactions so easy to remember as acid that is anaphylaxis cytotoxic immune mediated and delayed type of hypersensitivity reactions just a word about a little more detail so that you can go home with little more learning that just simple mnemonics so type 1 or anaphylaxis is an immediate type of high percentage reaction which occurs in a matter of minute to an hour maximum in its ig mediated type 2 is the cytotoxic which is igg or igm mediated and the example is the hemolytic anemia homozymolytic type anemia it can occur in matter of hours two days then immute complex mediated that can take anything from one to three weeks and the example is the serum sickness kind of illness and type 4 is a delayed kind of hypercentric reactions which can take days to weeks and the examples are like sj syndrome or certain dresses another emergency it's a rare condition but it's very important that in rare condition also we may not remember it unless there is some easy way of remembering it this is particular conditions you know acute internal coherence not common but the constellation of five different symptoms or signs if we recollect and then if we happen to see that patient probably we at once think of porphyra it is in the form of somebody complaining of severe abdominal pain with the portwine urine and psychological abnormalities which could be in the form of delirium or hysteria or anxiety agitations then some of the symptoms like acute pain or the convulsions precipitated by drugs like barbiturates or sulfur oral contraceptive pills and patients having polyneuropathy so next time if you have a patient who is complaining of abdominal pain with neurological disturbances peripheral neuropathy and altered color of the urine think of porphyria and just send the urine for portfolio nation and maybe you get the diagnosis this is very interesting we know kidney functions kidney is one of the very important organ of our body and carries out so many functions few functions probably everybody would know but these are the seven sets of functions just in a form of kidney function is a weight bed so what are this a wet bed stands for we know that kidneys mainly involved in the balance or homeostasis of acid-base homeostasis kidney is main function is to excrete acid because acid is the one which we generate so many out of metabolic activities and the routine activities so kidneys try to acidify urine and that way of dispose the extra acids one which cannot be controlled with the or the which the bicarbonates cannot cope up the kidney excretes the acidic urine so acid a for the acid-base distance water another right whatever amount of water we take or less water we take kidney will bring the venezuelans of the water so water balance acid base balance water balance electrolyte balance sodium potassium especially are maintained by the kidneys right then the t for toxic removals there are so many toxic compounds which can be removed by the kidneys then b stands for the blood pressure control then e for the erythropoietin or the anemia see control of mercedes homobiotic factor and d for the vitamin d so if you remember weight bed acid-based balance water balance electrolyte balance then toxin removal then blood pressure control anthropoitine uh helping the hemopoisis and the vitamin d metabolism in the form of active vitamin d that is one twenty five hydroxycholes cholesterol that is very very important because the active vitamin d only helps in controlling the calcium absorption right as well as the expression of the phosphorus so weight bet is easy to remember all the functions of the kidney we do intend to carry one more talk sometime in the next year that is 2022 about the renal functions will be talking again in detail about the kidney functions there then sometimes the mnemonic can be in the form of a sentence that gives the pictures or the clinical pictures of many of the symptoms of a particular disease again not may not be so very common like so when somebody says stones bones abdominal groins and psychiatric overtones it looks like a lyrical statement but it can give the clear-cut picture of the symptoms of hypercalcemia somebody who has this the renal calculi who has the bony pains with the abdominal colical pains are the alias then psychiatric overturns the irritability and all these are the symptoms of hyperkalemia so next time when somebody has this kind of symptoms do remember and sandy blood for calciums then symptoms of prosthetic enlargement one more generally ah symptoms that we know that prosthetic enlargement is quite common in the people past 60 years and the symptoms can be related to the storage that is the retention of the uh the post-fossil post-white resilient urine in the bladder that gives symptoms of the storage related and sometimes because of difficulty in voiding because of the pressure over the prosthetic urethra so the if you remember fun and peace right then of course we know there is nothing fun about heat and the basins are always suffering but this for our convenience that we remember like fun fun stands for the frequency then urgency and nocturia these are the symptoms of prostratic enlargement frequency urgency nocturia then the avoiding related symptoms are in the form of pressure they are feeling of pressure the and that is hesitancy they have intermittent voiding of the urine they may have to strain and in spite of training they may not get the good flow of the urine and they are always a sense of incomplete pointing because of the increase in the force was post void residual urine so remembering fun and peace will definitely take care of these symptoms of prostatic enlargement it's easy to recall from the patients or recollect from the patients about the symptoms of prostatic enlargement then sometimes again the disease is not very common but that is where the mnemonics help suppose if somebody has say that which is the disease where the mnemonics www comes for right and this is a picture of that person who has come to you with the incontinence of the urine who has difficulty in walking right and he is wacky so that is if you can see the ct scan you can easily make out that there is a hydrocaphalus so symptoms of normal pressure hydrocephalus can be in the form of the urine incontinence attacks gate or dementia so next time when you see a patient who complains of urinary incontinence and difficulty in walking especially difficult in the gate right and who also have the symptoms of the memory lapses forgetfulness do think of normal pressure hydrocephalus this need not be just symptoms of old age right urinary incontinence may be a part of these symptoms but atoxic gait and dementia when they all together think of normal pressure hydrocephalus easy to diagnose if you think of it easy to treat if you know the it's a normal pressure hydrocaphalus it can easily be treated either by the intermittent letting of the csf or may be putting a sun then kawasaki disease again again the recognition because of the 19 we know that kawasaki disease is the common in children it's a one kind of vasculitis syndrome and which follows and any infections to a predisposed people and it's a very pretty serious disease and because of the covenant infections where children are not affected very commonly but there have been few cases of infection of children with the sarcoidovirus and when it occurred they might give a hyper immune response because the basically sars covetous response most of them are because of the hyperimmune response that is called as either cytokine storm or macrocyte activation syndrome that kind of all syndromes are attached with the kovid infections in children the kawasaki disease and kovidar kovid related inflammatory disease in children are not same but very similar initially thought it's a kawasaki disease but then they give a different name that is called a multi-system inflammatory syndrome multi-system inflammatory system in children or miscc that is what the currently the designation for the kawasaki like disease in children the in kawasaki disease whenever a child has cured for more than five days and when if he has got four symptoms of signs out of fire prison you investigate for kawasaki disease these five symptoms are given as a acronym of cream see for conjunctivitis this is a non-exudative or non-plural type of conjunctivitis then the rest which is non-vesicular res res then edema which may be in the form of erythema of the hands or the feet then cervical lymphadenopathy which may be unilateral and mucosal involvement in the form of swollen lips and the fishers are trusting and there may be the strawberry tongue all these features when they are present in a child who is more than five having fever for more than five days think of kawasaki disease and investigate then features of multiple myeloma we know that multiple myeloma is basically a disease of the old age it doesn't come in the before the age of 40 or 45 or 50. so if you want to remember the symptoms of multiple myeloma remember as old crab gold cage old stands for the old age c for the elevated calcium r for renal failure a for anemia and b for bone lytic lesions if we take the x-rays plane exercise you'll find the electric lesions in the bones whether it's a skull or a vertebra or the pelvis wherever you take action you might get a small light decline spun down punched out lesions in the x-ray so old crap is something for multiple myeloma now multiple myeloma we go for the investigations in the form of protein electrophoresis so that is where our this one of the last i told you that you remember this right at the end we started with the knuckles and we are going to finish with this particular this particular picture itself gives lot of informations when it comes to protein electrophoresis we know protein electrophoresis is one there is a different types of proteins are given in a graphical form depending on how their lines come up on the chromatographic paper right so it are all conforms of wave right so next time when you see an protein electrophoresis see if you just put it like this the thumb is the gamma globulin the middle three fingers are the alpha one alpha twelve beta glubulin and the little finger is the albumin so if you remember this right and when you see this kind of picture where the thumb part as well as the little finger showing the towers and the others are in the normal range you are dealing with a hyper monoclonal gammopathy that is the multiple myeloma but many times the patient says increase globally but it is not in the form of gamma globulin but maybe one of the other globalists like alpha two globulins or alpha one groups or beta globulins these are basically the acute phase reactants all proteins could be a part of acute phase reactants so if the electrophoresis the picture is suggest you of too many views and one of them none of them is a tower form maybe you can think of that privilege say not the multiple myeloma type but some other kinds of gammapathy but if there is a huge spike in the gamma range then you should think of multiple myeloma so this is how we take the look at the oil press so it's not that we cannot make it we can also make the mnemonics the way we want it but we have to remember that there are certain rules for it right you can't you ideally you should avoid the mnemonics which use the foul language or his scene or is insulting or it is hurting or humiliating that should be definitely avoided if you go through the internet you'll find so many of the options also words and that of course it is easy to remember for most of the people but that's not something you should we remember this kind of mnemonics there are so many of them i just cannot name even one for you right and that's better we avoid all those kinds of the mnemonics which do not uh are the one which are weak what we call it the formal parliamentary language right so we avoid those offending or hurting type of the words we use otherwise mnemonics are the best way to remember and there are so many of them i'm sure you are going to come out with so many of them on your own also or when the stage is open for you so then the last abbreviation thanks thank you and now it's up to the audience try to give their own account of the different kinds of mnemonics they have come across or they thought that we would try to we would have included it we have few in the line but i thought that let's now first discuss out uh the mnemonics that you want us to know or the other viewers want us to know so yes ruja yes yeah and thanks a lot for explaining you didn't just explain all the mnemonics a bit around that few concepts around that so yeah it was really great uh so today we won't have q a session instead we will do a raise hand thing you can come on stage share your mnemonics with us uh till you uh raise your hand i'll just uh quickly uh take one interesting question that we had in the comment box so dr sean is asking we have uh in prescription bd uh this indie and od one study that we use is that an acronym or an absolution so sir explained everything so could you just quickly address that and i'll just speak you raise that though when it's a certain form obviously it's an abbreviations right it's an abbreviation but there's a certain mnemonics we use it can be acronyms also but basically these are all the definitely abbreviations right great uh so i can see three raised hands uh you know i can share one mnemonic with you which we often use in obstetrics this is called a tifa scan d-i-f-f-a yeah that is targeted imaging for fetal anomalies that's a very very catchy mnemonic yeah and uh used and uh you know incidentally it also fitted with the white all right quickly go great uh the users in the morning till then yeah so yeah this was interesting one yeah yeah yeah somebody suggested that drugs causing pulmonary fibrosis remember all four modes of transport that is bus for busy fun c for cyclophosphate cycle for cyclophosphamide trained for trimethoprim and drone as amiodarone wonderful a very good one thanks to the contributor so uh dr poonam uh had shared this with us uh we have two more winners thank you yeah yeah so we can go to yeah yeah the next science of core pulmonal by the sentence please read his text that is p for peripheral edema r for raise jvp h for hepatomegaly and t for tricuspid incompetence so basically these are the science of chronic core formula science of heart failure in the form of edema and rays neck veins hepatomegaly and tricacil incompetence as the extreme form of pulmonary hypertension again a good one then the third one is the big one yeah crohn's disease we know that crohn's disease is something it's a one kind of inflammatory bowel disease where we have to remember christmas right this is the right time to remember that so there are different signs and symptoms put in this particular acronym that see for the cobblestone appearance then high temperature fever they may present as puo then reduce lumen on the barium or the ct scan then intestinal fistula is one of the complications skip lessons is the one very peculiar of the crohn's disease on the endoscopy that is colonoscopy then the lesions are transmural that is through and through it's not only restricted to the mucosa then abdominal mall absorption is obviously the result of this inflammatory bowel disease abdominal pain and sub mucous fibrosis in the end so christmas easy to remember all different features of cross disease a good one but it's not that easy to remember but at least we can recollect most of the symptoms and signs because of the acronym that is christmas thank you very much again good one so thank you dr nishant uh bodhi dr prudhv reddy and dr presumption these were really uh insightful mnemonics that you have shared uh to every participant please uh you can raise hand come on stage or share your insights directly with us your uh i'll just read out uh which are there in the comments so so for remembering the layers of scalp we have svalp like the as a scalp is dr uh dr anupriya is saying uh you also have to come out with the different names for these scalp means which are the layers yeah when we have got so many we are still waiting i can set with many of the mnemonics for their use also if you allow me to present yeah we remember mnemonics in emergency for the acls that is the advanced cardiac life support right that one of the important mnemonics are the one liners for the different kinds of ecg changes that we might see in a patient which i just had cardiac arrest one could be pulseless electrical activity where you may have please clear everything away that each phosphate is the action that we are supposed to take i will explain it again in a minute then for sinus bradycardia patient is revived but he has persistent sinus bradycardia then what we should do is a part of advanced cardiac life support that is acls is prompt action ends deadliest equally again each first letter we give the what we are supposed to do for that particular ecg abnormality and if the patient has persistent vtvf after reviving from the cardiac arrest we have to remember it's we have to scream that is exactly what we are supposed to do in emergency and so we can take this one by one so for algorithm for ac stereo or pulseless electrical activity patient might have regained the spontaneous respirations but his uh seal is hypotensive and there are few pulseless electrical activity in that case first we now these are the advanced cardiac life support that means the patient is in safety to the hospital we have got the support of paramedics and the other doctors also in the other investigations so we should try to get the problem what is the problem that we have to start simultaneously along with starting giving continue giving the cpr so p stands for the find out the problems these problems could any of the five h or five t so five h problems for this kind of uh the revival could be hypoxia hypovolemia hyper or hypokalemia hypoglycemia or increasing the h ions that is acidosis similarly 5 2 could be tensile pneumothorax tamponade cardiac tamponade it could be toxic conditions it could be thermometer conditions like pulmonary embolisms and it could be trauma so when the patient has revived his respiration part is required but still has got the pulseless activity it could be any of this and we need to act on this we can get actually we can get ecg we can get the blood samples and sonograph electrocardiogram anything then we have to continue doing cpr in the form of the thirties to two the external chase comparisons and the mark breathing for next two minutes that is four cycles then we give epinephrine previously there used to be vason pressing as the second after first dose of epinephrine but that vessel now present is not no longer now recommended we continue giving epinephrine without recovering remembering how many atropines we are epinephrine we have given because epi nephron is a very short half-life and we can repeat every three to five minutes one milligram goes intravenously then we can we should also give atropine atropine there is a fixed limit that we should give only three dosages of atropine uh one milligram every every three to five minutes so for the patients with pulseless electrical activity search for the problems continue giving cpr give epinephrine one once you might give us operation and atropine and meanwhile you find out the problems and maybe you can revive the patients then for persons with the symptomatic bradycardia now here the patient is recovered but he is bradycardia so there is an increased vehicle tone or there is something to do with the sinus node for dysfunctions so here the prompt action ends deadly secretly prompt action ends deadliest equality so p stands for the prepare for the temporary pacemaker temporary transcutaneous spacing that is what we should do then we give again the entropy same we like the pulseless electrical activity give one milligram push every three minutes for next three dosages then give epinephrine if that doesn't work start the dopamine infusions and again search for the treatable cause so that is the algorithm for symptomatic bradycardia and for vtvf algorithms yeah yeah please yeah so uh you just explained uh rational behind uh use of hydropin uh but is there anything like according to recent acls guidelines we are not using or it is still there and it's very much yeah then we we use it definitely we use it i'm not sure if there's the latest means the very latest guidelines but as far as i know uh entropy is used only thing is beyond three euros uses now beyond three dosages we don't use it and for algorithm for pulseless uh vtvf screen that is the first give us shock here we give the if you have got a monophysi we got 360 you have a buy phase you can give 250 or 200 watt is the highest for that difficulty machines then repeat every two minutes if required continue giving cpr for two minutes right in which you don't have to check for the rhythm for the two minutes then check for the rhythm after two minutes and see whether it is talkable rhythm then again keep shocking it giving saw shocking it and giving the epinephrine one by one is definitely what you should do but after two rounds of two minute cpr and the stock you may give an amiodarone infusions or a lignocon once and if that fails you try magnesium sulphate so this is the algorithm for vtvf somebody said isoprenal is an integral integral yeah that is true that means now instead of dopamine we can use isoprene ahead of the i mean now even norepinephrine is used ahead agree then this is uh you can say mnemonic in the form of a poem for the heart block right we know that first degree hard block second degree hard block and third degree hard block or the new commands or the very newer ones it's maybe easily not easy to remember we know first degree hard block is the prolonged pr interval so what the poem goes if the r i'll have to expand it if the r is far from p that is if the pr interval is prolonged then it is the first degree hard drop longer longer longer and drop then you have got a vanquish phenomenon without any work phenomena subsequent pure the complexities will have prolonged pr till one p is not conducted or that we call it p is dropped so longer longer longer and then drop that means pr interval is prolonged till one p is not conducted and that is what is venky back phenomena or mobius type uh one plot then obvious type two block is that some p do not get through here the pr interval is constant it is prolonged or normal but it is constant but at regular or irregular interval the p is not uh conducted right there is some ps don't get through then you have movies type two and if ps and cues don't agree that means atria and ventricles are contracting in their own idio syncretic rhythms that is atria is contracting at their own sinus rhythms rate as well as the ventricles at the individual rhythm and there is no connections between the atrial and the ventricular rhythm that we call it a third degree hard block or a complete heavy dissociation so prolonged pr first degree increasing pr interval till one piece drop is the ven quebec phenomenon p which is not conducted at regular or irregular interval is the mobius type two block and mobis type one and mobius type two are means two wenky bacon movies type two out of the second degree block and the third degree block or a complete hard block is where the atrias and ventricles do not uh are associated or there is only complete heavy dissociation then this one is the one we use for the organophosphorous poisoning you know there is an organ for poisoning there is an acetylcholine axis right so we get all these symptoms of the activity of the all the secretary glands and the bronchi and that is why it's an economies in the form of dumbbells d for diarrhea and for severe perspirations and diarrhea then e for urination am for small pupil b for bronchospasm and bronchoria e for emesis alpha lacrimalism and as for salivation so if a patient is brought uncaused season he has had history of severe perspiration diarrhea his pupils are small and on auscultation there is crepitations and rhonchi right that then you always think of the organophosphorous poisoning and if the very smell also would be very typical kerosene make smell and the pupils are one of the very important point in the patient which is unconscious so dumbbells is for the muscarinic effects of the organ of phosphorus poisoning then causes of coma we know there is a coma can have innumerable causes the easy way to remember is the all the uh vowels that is eiou plus t so e stands for the endocrine cause like hypoglycemia or electrolyte disturbance in the form of hyponatremia or encephalopathy infections then i for the infections encaphalopathy could be metabolic also of course then oh for the hypoxia oxygen overdose of the we always think of the poisoning whenever the patient has got the patient is unconscious or it could be opiates again here the respiratory pupils all are important to come to the narrow down the cause of coma then u for uremia t for trauma then there is the thiamine that is vernix and papillopathy overnight kosikov encephalopathy and a thymine deficiency in alcohol patients and hyper or hypothermia can also produce the coma eye for insulin that is hyper hypoglycemia mainly hypoglycemia the patient is deeply unconscious it's more likely to be hypoglycemia than hyperglycemia and p4 poisoning so yeah eiou tip is for the causes of coma somebody has raised the end so let us first listen to them hi hello this is dr there is a modded for memorizing the layer of manages good one you always forget that which one is the outer and which was the inner layer so good one yeah now thank you dr chetna hello yeah hello yeah you can hear we cannot see you but we can hear you yeah yes excellent session sir and uh one more thing just i wanted to see uh highlight a fast hug for a critical care patient rounds usually uh while taking the icu rounds many of the things we overlook it so we used to uh remember a fast step where f stands for feeding of patients usually this is for the critical patients like a ventilated patients a for analgesia of the patient yes for sedation of the patient t is for thrombo prophylaxis of the patient each is hyperactive or hypoactive deliriums right u is ulcer prophylaxis and g is glucose monitoring so this is one of the common unique used in icu care patients while taking their very good one definitely thank you so much yeah we used to enjoy you know recent series right right so there are so many of them and there is what our idea is that we can recollect and collect it and just put the ur all of you can get this as a replay and the recording will be available soon so all this is added thank you so much thank you anybody else yeah yeah right so definitely this is the limited or systemic class scleroderma we do some micro come across the crest syndrome it is called crest that is calcinosis reynolds phenomenon esophageal disem in the rheumatology we do come across occasionally then 5 is for the symptoms of alzheimer's disease that is the anomia difficulty naming remembering the name then apraxia difficulty in understanding and there is a difficulty to come out with the function then agnosia then amnesia and the aphasia so these are five ways for the alzheimer's disease then this is a general one i just added it i given you that we will be able to show this uh this one is the knowing the exact position of the earth right in the power solar system so the sentence goes see my very educated mother just showed me sodas nine planets well it's all starts with the mercury right that venus it starts with sun mercury venus then the earth of course mars jupiter saturn uranus and neptune and pluto right this is not easy to remember if this is one probably the most difficult one remember all the steps in the krebs cycles or the triceratic urea cycle or grape cycles so this is a can i ask some super fantastic memes on so it starts with the c for citrate i for isocitate a for alpha glucorate then as for i'll have to see i am not very familiar with this thing say as for succinylcholine then super for succin net f for fume rate m for mallet and o for oxaloacetate so this is the whole krebs cycle or urea cycle by remembering can i ask some super fantastic memories on right then this is in the form of pictorial form right i hope somebody can find out from the very picture that what could be this syndrome right a person who comes with the typical cow little finger or a single palmer crease small ear slanting eyes bridged nose then there is an epicanthus fold right there are brussels spots is upward slanting eyes fat round face right fister tongue there may be some deferment like esd or mitral wall prolapse then there is a big gap between the great toe and the second toe and there may be there is a trisomy of the chromosome 21 that comes the diagnosis that is down syndrome yeah that somebody is likely to come out on syndrome this is very interesting very simple movement is we always have difficulty in finding out when we come to the selective beta blockers what is the b1 beta blockers and b2 bleed b2 types of receptors right so it's very easy b1 receptors are in the heart and beta 2 receptors in the lungs so is it remember we have one heart in two lungs i think one of the easiest way to remember it that b1 is for the cardiac specific and b2 is is the broncos specific right good one then this is not that easy right the acid-base disturbances uh it's not easy everyone's cup of tea right and usually it is left to the critical specialist or the anesthesiologist or the pulmonologist to interpret but in emergency we have to know so ph we know when it is low it is called acidosis where it is accumulation of the h ions and when it is the high it is alkalosis it's a process acetosis and alcohol is another process while alkaline acidemia are the results in the blood right so what this says the robe method in rome method remember that resp respiratory is opposite and metabolic is equal so if the ph is down and co2 is opposite right that is respiratory acidosis while in metabolic or i would say even simpler than that if you just put ph right then pco2 and hco3 you just make three columns one was ph another is a pco2 and another hco3 the partial pressure of the carbon dioxide and the blood levels of the bicarbonates if all three arrows are down easiest remember all three arrows are down right that is ph is low why bicarbonates are low and pco2 is low it is metabolic acidosis all three arrows down metabolic acidosis all three arrows up it is metabolic calculus ph is more pco2 is more and my carbons are more so i thought that was easier than this right then so these are the then for the abdominal pain differential diagnosis it is in the form of abdomen abdominal only that is appendicitis biliary disease diverticulitis ovarian disease malignancy intestinal diverticulosis intestinal obstruction then neoplastic disease ah i mean sorry nephritis malignant we already said nephritic disease then acute pancreatitis and like coral alcohol so for abdominal pain differential diagnosis remember abdomen ah sometimes in undergraduate exams we do ask questions like which are the pure sensory nerves remember tuning fork the frequency that is one two eight so one two eight is the pure sensory now and pure motor know is three four eight eleven twelve and the mixed nerves are five seven nine ten not sure is the easiest one is probably the pure sensory now these are i think we can stop here right if there are any comments right yeah so he's just commented dr narayanan uh there is one self-made one uh so so if you would like to come on stage and explain that will be really great okay so it is actually doctor scam drs we just take it as doctor's cab so d is for uh danger scene or scene safety because many of the times in the bl sequence we just remember cab circulation everything we tend to forget the initial more important steps the first is scene safety so that is for d danger r is for response we see whether the patient is responding then this is for uh uh seek help after that see a b certain question right so doctor step yeah circulation right good one yeah yeah thank you sir thank you thank you so much yeah with this i can uh i think we can end the session now therefore thanks a lot thank you and we always end with a word of caution about the uh with appropriate behavior that is now that we know that omegron has spread its wings to the entire pan india so it's what duty to make sure that everybody keeps the social distancing where the mass not only the mass probability i would suggest for the double mass when we are very close or when we examine and the senate use of sanitizations and whenever the booster rules is available we should go for it right uh so have a wonderful year end celebrations but with all the precautions that we should take right we don't want to repeat the a 9 20 20 april's scenario where we had all the hectic activities and front of beds people are moving around here and there in front of oxygens and all that we don't want it so let's hope that that day doesn't come and it seems that probably it will not but then still the sheer number increases and the people go panic and it's because of that that so many people would go for and occupy the hospitals and occupy the beds and would not be available for the ones who really need it so that is why we better prevent it that large scale infections and it's very very important that this particular time omicron has the symptoms of a common cold so at least if we can give vaccines for the influenza vaccines then also that part would also go out of our differential diagnosis which is effective so i for one would believe that we should also advocate the influence of actions to most of our patients right right thank you all it was a wonderful session a wonderful audience and the participations and we also learned many which we did not think of as yes while preparing and i'm glad that i could even add few more after our thank you so much good night goodbye take care stay safe thank you

BEING ATTENDED BY

Dr. Murtuza Zozwala & 2004 others

SPEAKERS

dr. Mahadev Desai

Dr. Mahadev Desai

Senior Consultant Physician | Ahmedabad

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dr. Rohan Desai

Dr. Rohan Desai

MBBS | MBA, IIM-A | Founder & CEO, PlexusMD

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dr. Mahadev Desai

Dr. Mahadev Desai

Senior Consultant Physician | Ahmedabad

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dr. Rohan Desai

Dr. Rohan Desai

MBBS | MBA, IIM-A | Founder & CEO, PlexusMD

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