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Motor Hand Exam

3/27/2024

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Motor Hand Exam

"Rock-Paper-Scissors-OK": A Mnemonic for Assessing Upper Limb Nerve Function

The "Rock-Paper-Scissors-OK" mnemonic is a valuable tool used by healthcare professionals to quickly and efficiently assess gross motor function in cases of suspected upper limb nerve injuries. Each hand gesture in this mnemonic represents a specific nerve and its associated motor functions:

1. Rock (Median Nerve):

To assess the median nerve, ask the patient to make a tight fist with their thumb tucked inside. This action is controlled by the median nerve, which innervates the muscles responsible for flexion of the fingers and opposition of the thumb. Inability to form a complete fist or difficulty tucking the thumb may indicate median nerve damage.

2. Paper (Radial Nerve):

To assess the radial nerve, instruct the patient to extend their wrist and spread their fingers, mimicking the flat "paper" gesture. This action tests the radial nerve, which innervates the muscles responsible for wrist and finger extension. Weakness in wrist extension or difficulty spreading the fingers can suggest radial nerve involvement.

3. Scissors (Ulnar Nerve):

To assess the ulnar nerve, ask the patient to spread their index and middle fingers apart, forming a "scissors" shape. This movement is controlled by the ulnar nerve, which innervates the muscles responsible for abduction and adduction of the fingers. Difficulty performing this action or weakness in finger abduction may indicate ulnar nerve damage.

4. "OK-Sign" (Anterior Interosseous Nerve):

To test the function of the anterior interosseous nerve, instruct the patient to make the "OK" gesture by touching the tip of their thumb to the tip of their index finger, forming a circle. This action is controlled by the anterior interosseous nerve, which innervates the muscles responsible for flexion of the interphalangeal joints of the thumb and index finger. Difficulty forming the "OK" sign may suggest an issue with the anterior interosseous nerve.

Important Note:

While the "Rock-Paper-Scissors-OK" mnemonic provides a helpful framework for conducting a quick motor hand exam, it is essential to remember that it is not a definitive diagnostic tool. Healthcare professionals should always consider the patient's history, symptoms, and additional clinical findings to make an accurate diagnosis and formulate an appropriate treatment plan.

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Drugs for Poisoning Treatment

3/27/2024

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This is a list of DRUGS for POISONING TREATMENT:

Paracetamol poisoning: N-Acetyl cysteine.
Organophosphate poisoning: Atropine and pralidoxime.
Methanol poisoning: Fomepizole or hemodialysis.
Ethylene glycol poisoning: Fomepizole or hemodialysis.
Methotrexate toxicity: Folinic Acid.
Warfarin poisoning: Vitamin K.
Heparin poisoning: Protamine sulfate.
Iron poisoning: Deferoxamine.
Copper poisoning: D-Penicillamine or Zinc acetate.
Carbamate poisoning: Atropine.
Calcium channel blocker poisoning: Calcium gluconate or calcium chloride.
Anticholinergic drug poisoning: Physostigmine.
Methylxanthines or theophylline poisoning: Beta blocker.
Ergot alkaloid poisoning: Sodium nitroprusside.
Alpha 1 agonist poisoning: Phentolamine.
Beta 2 agonist poisoning: Propranolol (contraindicated in asthma patients).
Carbon monoxide poisoning: Hyperbaric oxygen therapy.
Beta blocker poisoning: Glucagon.
Tricyclic antidepressant (TCA) poisoning: Sodium bicarbonate.
Isoniazid (INH) poisoning: Vitamin B6 (pyridoxine).
Cyanide poisoning: Cyanokit (hydroxocobalamin), or Cyanide Antidote Kit (Amyl Nitrite, sodium nitrite, and sodium thiosulfate).

Opioid overdose: Naloxone.

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Case Report 1 (Syncope)

3/27/2024

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"Educational Case Report" is dedicated to providing informative and engaging case reports across various medical disciplines. Our goal is to share real-world patient cases that offer valuable learning opportunities for medical students, healthcare professionals, and anyone interested in the field of medicine.

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Chest X-Rays for Trauma

3/27/2024

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Chest X-Rays for Trauma

If any rib fracture is present, investigate for potential pneumothorax or pulmonary contusion.
In the event of a fracture involving the first three ribs or sternoclavicular dislocation, airway or great vessel injury should be suspected.
Fractures of the lower ribs, 9th to 12th, may indicate an associated abdominal injury.
The presence of two or more rib fractures in multiple locations raises concern for flail chest or pulmonary contusion.
Scapular fractures warrant evaluation for potential great vessel injury, pulmonary contusion, or brachial plexus injury.
Mediastinal widening should prompt consideration of great vessel injury, sternal fracture, or thoracic spine injury.
A persistent large pneumothorax or air leak after chest tube insertion may signify a bronchial tear.
Mediastinal air warrants investigation for esophageal disruption, tracheal injury, or pneumoperitoneum.
A loculated gastrointestinal gas pattern in the chest may indicate diaphragmatic rupture.
If a nasogastric tube is visualized within the chest, diaphragmatic rupture or ruptured esophagus should be considered.
An air-fluid level in the chest may represent hemopneumothorax or diaphragmatic rupture.
A disrupted diaphragm raises suspicion for potential abdominal visceral injury.
Free air observed under the diaphragm may signify a ruptured hollow abdominal viscus.

If you observe respiratory distress without radiographic findings, consider the possibility of central nervous system injury, aspiration, or traumatic asphyxia.

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Activated Charcoal for Poisoning Management

3/27/2024

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Activated Charcoal in Poisoning Management:

Activated charcoal is crucial in managing poisoning cases in emergency departments. Its use is indicated within 60 minutes of ingesting certain toxic substances, including antidepressants, aspirin, aminophylline, barbiturates, carbamazepine, digitalis, dilantin, dapsone, and quinine.

Dosage of Activated Charcoal
The recommended dosage of activated charcoal varies depending on age:

Adults: 25 to 100 grams in 300 to 800 ml of water.
Children (age 1 to 12 years): 0.3 to 1 g/kg, or 25 to 50 grams, in 300 ml of water.
Infants: 0.5 to 1 g/kg, or 10-25 grams.

Multidose Activated Charcoal

In cases of toxic ingestion involving agents that undergo enterohepatic reabsorption, multidose activated charcoal is recommended. These agents include carbamazepine, theophylline, phenobarbital, dapsone, and quinine.
Multidose activated charcoal, if indicated, may be administered by repeating half the recommended dose every 4 hours.

Complications of Activated Charcoal

Pulmonary aspiration and a resulting aspiration pneumonitis are the most concerning risks of administration of activated charcoal. In patients with a depressed level of consciousness, providers must consider the risk-to-benefit ratio of intubation for airway protection and the therapeutic benefits of activated charcoal.

Contraindications of Activated Charcoal

Activated charcoal is contraindicated in patients with decreased level of consciousness, increased risk of gastrointestinal bleeding or perforation, and for substances for which charcoal is ineffective or poses a risk of aspiration.
These substances include caustics or corrosives such as acids and alkalis, hydrocarbons, metals such as iron and lithium, alcohols such as ethylene glycol, ethanol, and methanol, and solvents such as household cleansers.

Indications of activated charcoal in poisoning caused by pesticides remain controversial due to unknown efficacy and risk of aspiration.

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Motor Hand Exam

Drugs for Poisoning Treatment

Case Report 1 (Syncope)

Chest X-Rays for Trauma

Activated Charcoal for Poisoning Management

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