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Sports Hernia

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161. Developmental rheumatology in children. Scenario: Clumsy child

activities [ ; ]. Other causes of heel pain in children and adolescents include [ ; ]: Achilles tendinitis — rare under 14 years of age. May occur in jumping athletes and people with a sudden increase in sporting activity. Retrocalcaneal bursitis — may be caused by traumatic overactivity. Calcaneal fracture — stress fractures occur with repetitive trauma and may be misdiagnosed as a foot sprain. Fractures can also result from injuries such as a fall from a height, or direct blow to the calcaneus (...) sportspeople and dancers [ ]. Some people are symptomatic — this is known as joint hypermobility syndrome. Features include joint hypermobility with muscle and joint pain and fatigue, especially in the evening after an active day; late walking with bottom shuffling instead of walking; poor handwriting and ball catching skills; and, rarely, easy bruising and joint clicking; abdominal pain which may be associated with bladder and bowel dysfunction; postural orthostatic tachycardia syndrome (POTS); hernia

2019 NICE Clinical Knowledge Summaries

162. Developmental rheumatology in children. Scenario: Tip-toe walking

activities [ ; ]. Other causes of heel pain in children and adolescents include [ ; ]: Achilles tendinitis — rare under 14 years of age. May occur in jumping athletes and people with a sudden increase in sporting activity. Retrocalcaneal bursitis — may be caused by traumatic overactivity. Calcaneal fracture — stress fractures occur with repetitive trauma and may be misdiagnosed as a foot sprain. Fractures can also result from injuries such as a fall from a height, or direct blow to the calcaneus (...) sportspeople and dancers [ ]. Some people are symptomatic — this is known as joint hypermobility syndrome. Features include joint hypermobility with muscle and joint pain and fatigue, especially in the evening after an active day; late walking with bottom shuffling instead of walking; poor handwriting and ball catching skills; and, rarely, easy bruising and joint clicking; abdominal pain which may be associated with bladder and bowel dysfunction; postural orthostatic tachycardia syndrome (POTS); hernia

2019 NICE Clinical Knowledge Summaries

163. Developmental rheumatology in children. Scenario: Bow legs in children

activities [ ; ]. Other causes of heel pain in children and adolescents include [ ; ]: Achilles tendinitis — rare under 14 years of age. May occur in jumping athletes and people with a sudden increase in sporting activity. Retrocalcaneal bursitis — may be caused by traumatic overactivity. Calcaneal fracture — stress fractures occur with repetitive trauma and may be misdiagnosed as a foot sprain. Fractures can also result from injuries such as a fall from a height, or direct blow to the calcaneus (...) sportspeople and dancers [ ]. Some people are symptomatic — this is known as joint hypermobility syndrome. Features include joint hypermobility with muscle and joint pain and fatigue, especially in the evening after an active day; late walking with bottom shuffling instead of walking; poor handwriting and ball catching skills; and, rarely, easy bruising and joint clicking; abdominal pain which may be associated with bladder and bowel dysfunction; postural orthostatic tachycardia syndrome (POTS); hernia

2019 NICE Clinical Knowledge Summaries

164. Developmental rheumatology in children. Scenario: Flat feet in children

activities [ ; ]. Other causes of heel pain in children and adolescents include [ ; ]: Achilles tendinitis — rare under 14 years of age. May occur in jumping athletes and people with a sudden increase in sporting activity. Retrocalcaneal bursitis — may be caused by traumatic overactivity. Calcaneal fracture — stress fractures occur with repetitive trauma and may be misdiagnosed as a foot sprain. Fractures can also result from injuries such as a fall from a height, or direct blow to the calcaneus (...) sportspeople and dancers [ ]. Some people are symptomatic — this is known as joint hypermobility syndrome. Features include joint hypermobility with muscle and joint pain and fatigue, especially in the evening after an active day; late walking with bottom shuffling instead of walking; poor handwriting and ball catching skills; and, rarely, easy bruising and joint clicking; abdominal pain which may be associated with bladder and bowel dysfunction; postural orthostatic tachycardia syndrome (POTS); hernia

2019 NICE Clinical Knowledge Summaries

165. Developmental rheumatology in children. Scenario: Curly toes in children

activities [ ; ]. Other causes of heel pain in children and adolescents include [ ; ]: Achilles tendinitis — rare under 14 years of age. May occur in jumping athletes and people with a sudden increase in sporting activity. Retrocalcaneal bursitis — may be caused by traumatic overactivity. Calcaneal fracture — stress fractures occur with repetitive trauma and may be misdiagnosed as a foot sprain. Fractures can also result from injuries such as a fall from a height, or direct blow to the calcaneus (...) sportspeople and dancers [ ]. Some people are symptomatic — this is known as joint hypermobility syndrome. Features include joint hypermobility with muscle and joint pain and fatigue, especially in the evening after an active day; late walking with bottom shuffling instead of walking; poor handwriting and ball catching skills; and, rarely, easy bruising and joint clicking; abdominal pain which may be associated with bladder and bowel dysfunction; postural orthostatic tachycardia syndrome (POTS); hernia

2019 NICE Clinical Knowledge Summaries

166. Developmental rheumatology in children. Scenario: Growing pains

activities [ ; ]. Other causes of heel pain in children and adolescents include [ ; ]: Achilles tendinitis — rare under 14 years of age. May occur in jumping athletes and people with a sudden increase in sporting activity. Retrocalcaneal bursitis — may be caused by traumatic overactivity. Calcaneal fracture — stress fractures occur with repetitive trauma and may be misdiagnosed as a foot sprain. Fractures can also result from injuries such as a fall from a height, or direct blow to the calcaneus (...) sportspeople and dancers [ ]. Some people are symptomatic — this is known as joint hypermobility syndrome. Features include joint hypermobility with muscle and joint pain and fatigue, especially in the evening after an active day; late walking with bottom shuffling instead of walking; poor handwriting and ball catching skills; and, rarely, easy bruising and joint clicking; abdominal pain which may be associated with bladder and bowel dysfunction; postural orthostatic tachycardia syndrome (POTS); hernia

2019 NICE Clinical Knowledge Summaries

167. Developmental rheumatology in children

in children and adolescents include [ ; ]: Achilles tendinitis — rare under 14 years of age. May occur in jumping athletes and people with a sudden increase in sporting activity. Retrocalcaneal bursitis — may be caused by traumatic overactivity. Calcaneal fracture — stress fractures occur with repetitive trauma and may be misdiagnosed as a foot sprain. Fractures can also result from injuries such as a fall from a height, or direct blow to the calcaneus. Calcaneal tumours — rare. Often presents (...) — this is known as joint hypermobility syndrome. Features include joint hypermobility with muscle and joint pain and fatigue, especially in the evening after an active day; late walking with bottom shuffling instead of walking; poor handwriting and ball catching skills; and, rarely, easy bruising and joint clicking; abdominal pain which may be associated with bladder and bowel dysfunction; postural orthostatic tachycardia syndrome (POTS); hernia; and joint sprains or dislocation. Overlap with developmental

2019 NICE Clinical Knowledge Summaries

169. Gastrointestinal Complications (PDQ®): Health Professional Version

by the following three means: The type of obstruction. The obstructing mechanism. The part of the bowel involved. Structural disorders, such as intraluminal and extraluminal bowel lesions caused by primary or metastatic tumor, postoperative adhesions, volvulus of the bowel, or incarcerated hernia, affect peristalsis and the maintenance of normal bowel function. These disorders can lead to total or partial obstruction of the bowel. Patients who have colostomies are at special risk of developing constipation (...) ) Neurological lesions (cerebral tumors). Spinal cord injury or compression.* Paraplegia. Cerebrovascular accident with paresis. Weak abdominal muscles. Metabolic disorders Hypothyroidism and lead poisoning. Uremia.* Dehydration.* Hypercalcemia.* Hypokalemia. Hyponatremia. Depression Chronic illness. Anorexia. Immobility. Antidepressants. Inability to increase intra-abdominal pressure Emphysema. Any neuromuscular impairment of the diaphragm or abdominal muscles. Massive abdominal hernias. Atony of muscles

2018 PDQ - NCI's Comprehensive Cancer Database

170. Neck pain - cervical radiculopathy

Neck pain - cervical radiculopathy Neck pain - cervical radiculopathy - NICE CKS Share Neck pain - cervical radiculopathy: Summary Radiculopathy is a neurological state in which conduction is limited or blocked along a spinal nerve or its roots — it is differentiated from radicular pain, although they commonly occur together. Radicular pain is usually caused by compression of the nerve root due to cervical disc herniation or degenerative spondylotic changes, but radicular symptoms can also (...) disc herniation and spondylosis. Cervical radiculopathy is most prevalent in people aged 50 to 54 years, and the annual incidence in: Men is 107 per 100,000. Women is 64 per 100,000. Most people with cervical radiculopathy will improve regardless of the treatment. Around 88 per cent of people improve within four weeks with non-operative management. Assessment of people with suspected cervical radiculopathy should include: Excluding red flags features which suggest a serious spinal pathology. Asking

2018 NICE Clinical Knowledge Summaries

171. CRACKCast E011 – Neonatal Resuscitation

, hypovolemia, hyporeflexia in mod-severe hypoxemic encephalopathy: selective cerebral hypothermia in asphyxiated infants may protect against brain injury hypothermia at 33.5-34.5 degrees in the neonatal population leads to lower mortality and less neurologic disability at 18 months of age **controversy whether whole body vs. head alone should be cooled** start cooling within 6 hrs of birth and continue for 72 hrs 3) A quick review of specific neonatal disorders: Diaphragmatic hernia Meningomyelocele (...) Omphalocele Choanal atresia Pierre-Robin sequence Diaphragmatic Hernia: as soon as diagnosed, the child should be intubated! ventilation distends the stomach and worsen respiratory distress because it is in the chest cavity Meningomyelocele/Omphalocele: should not be placed on the their backs: put on their sides / stomachs cover the spinal defect in sterile gauze pads soaked in warm sterile saline infants with gastroschisis or omphalocele should be resuscitated and have the defect covered in plastic

2016 CandiEM

172. CRACKCast E043 – Spinal Injuries

, ETOH and failure to use restraints Other common causes in order: falls, violence, sporting activities 80% of spinal injuries are men 1) Describe the anatomical contents of the anterior, middle and posterior spinal columns (aka 3 column model of Denis) Anterior: alternative vertebral bodies and intervertebral disks surrounded by annulus fibrosis and anterior longitudinal ligament Middle: posterior portion of annulus and post vertebral wall, posterior longitudinal ligament, spinal cord, paired (...) methylprednisolone then infusion @ 5.4mg / kg/hr. Variable length of infusion 14) For whom is surgical intervention indicated immediately with a spinal cord injury Impingement on spinal cord by foreign bodies, herniated disks, bony fracture fragments or epidural hematoma 15) Define neurogenic shock and describe its management I prefer neurogenic hypotension (newest version of Rosen’s uses this). In contradistinction to spinal shock (see above), neurogenic hypotension is loss of vasomotor tone and lack of reflex

2016 CandiEM

173. CRACKCast E008 – Brain Resuscitation

is imminently herniating PaCO2 = 35-45 avoid hypoxia and hyperoxia PaO2: 80-120 (18% higher mortality when PaO2 =300 for long periods) Maintenance of body temperature fever is damaging to the brain (increases metabolic demand 10% per degree C) monitor core body temp: rectal, esophageal, bladder or vaginal temp managed with antipyretics, cooling with fans +/- misting, commercial cooling devices What about resuscitative mild hypothermia? stay tuned for question 3 but no clear mechanism Treatment (...) sure his toddler survives past age 5. - 18 hours ago Latest posts by Adam Thomas ( ) - July 2, 2018 - June 25, 2018 - June 21, 2018 Chris Lipp is one of the founding Fathers for CrackCast. He currently divides his time as an EM Physician in Calgary (SHC/FMC) and in Sports Medicine. His interests are in endurance sports, exercise as medicine, and wilderness medical education. When he isn’t outdoors with his family, he's brewing a coffee or dreaming up an adventure….. Latest posts by Chris Lipp

2016 CandiEM

174. CRACKCast E042 – Facial Trauma

with alcohol use 49% of maxillofacial trauma was ETOH related in one study (many from assaults) other common mechanisms include falls, animal bites, sports, and flying debris. much more common in unprotected vehicle users such as ATVs and motorcycles 32% of injured ATV riders will have facial injuries (correlated with serious injury) children < 17 years old, sports injuries are the largest source of facial injuries (20%) children < 6 years old most commonly suffer facial injuries from family pets (...) in a fracture of the inferior wall of the orbit and allowing herniation of orbital contents (especially the inferior rectus muscle). can have diplopia with up-gaze resulting from entrapment of the inferior rectus, and may have a visible paresis of their up-gaze. are also at high risk for retrobulbar hematoma and may present with exopthalmos. can also manifest paresthesias or anesthesia of the medial cheek and upper lip from stretching or compression of the V2 branch of cranial nerve five. on CT they have

2016 CandiEM

175. Clinical Practice Guidelines on Obesity

Clinical Practice Guidelines on Obesity OBESITY HPB-MOH Clinical Practice Guidelines 1/2016 Ministry of Health, Singapore College of Family Physicians, Singapore Academy of Medicine, Singapore Obstetrical & Gynaecological Society of Singapore Obesity & Metabolic Surgery Society of Singapore Singapore Paediatric Society June 2016 Endocrine and Metabolic Society of Singapore Singapore Association for the Study of Obesity Singapore Nutrition and Dietetics Association Sports Medicine Association (...) , and exercise and behavioural therapists. 1.3 Guideline development The Obesity CPG is developed by a committee appointed by the Health Promotion Board, a statutory board under the Ministry of Health. The committee comprises of specialists from the fields of endocrinology, surgery, paediatrics, family medicine, obstetrics and gynaecology, sports science and physical activity, nutrition and dietetics, behavioural sciences and psychology as well as public health specialists. The guidelines are developed

2016 Ministry of Health, Singapore

176. Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations Full Text available with Trip Pro

abdominal shape and location in the liver of the lesion to be resected. Mercedes-type incision should be avoided due to higher incisional hernia risk Moderate Strong 11. Minimally invasive approach LLR can be performed by hepato-biliary surgeons experienced in laparoscopic surgery, in particular left lateral sectionectomy and resections of lesions located in anterior segments There is currently no proven advantage of robotic liver resection in ERAS. Its use should be reserved for clinical trials (...) . Incision There are four major types of incision: median incision, right transverse incision with vertical extension to the xiphoid (J-shaped), subcostal incision extending to the left and bilateral transverse incision with vertical extension (Mercedes-type). According to the two largest retrospective cohort studies ( n = 1426 and 626 patients, respectively) including one or multiple control groups, Mercedes-type incision had the highest incisional hernia risk at one year [ , ]. Of note, perioperative

2016 ERAS Society

177. Inherited aortopathies including Marfan Syndrome

also been associated with vascular rupture[8]. Diagnosis and Management of inherited aortopathies, including Marfan syndrome Page 6 4. Arterial tortuosity syndrome (ATS) This is a very rare condition with marfanoid appearance, cutis laxa, hyperelastic soft skin, joint hypermobility and dislocations and herniae. Imaging reveals more widespread and tortuous involvement of the arterial tree [10]. 5. Turner syndrome (TS) TS is characterised by a woman of short stature who may present with delayed (...) a. Exercise carries risk to the aorta, therefore recommendations exist about Diagnosis and Management of inherited aortopathies, including Marfan syndrome Page 13 i. Avoiding participation in competitive sports or undertaking strenuous or highly exertive exercise in patients with a diagnosis of a syndromic aortopathy and in individuals with a dilated aorta [4] and ii. Avoiding heavy weight lifting (requiring straining) in all individuals with a diagnosis of a syndromic or non-syndromic aortopathy

2016 Cardiac Society of Australia and New Zealand

178. American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for Comprehensive Medical Care of Patients with Obesity

of Clinical Endocrinologists; ACE = American College of Endocrinology; ACSM = American College of Sports Medicine; ADA = American Diabetes Association; ADAPT = Arthritis, Diet, and Activity Promotion Trial; ADHD = attention-deficit hyperactivity disorder; AHA = American Heart Association; AHEAD = Action for Health in Diabetes; AHI = apnea-hypopnea index; ALT = alanine aminotransferase; AMA = American Medical Association; ARB = angiotensin receptor blocker; ART = assisted reproductive technology; AUC (...) and meta-analyses of these trials [EL 1]), in the interest of conciseness, derivative EL 4 review publica- tions that include many primary evidence citations (EL 1, EL 2, and EL 3) are also included. In addition, rigorously reviewed guidelines by other organizations have been adopted for specific issues, such as physical activity guide- lines by the American Academy of Sports Medicine (28 [EL 4; NE]), physical activity guidelines by the American Heart Association and the American College of Cardiology

2016 American Association of Clinical Endocrinologists

179. Back Pain ? Child

Sports Med. 2013;41(1):169-176. 25. Kjaer P, Leboeuf-Yde C, Sorensen JS, Bendix T. An epidemiologic study of MRI and low back pain in 13- year-old children. Spine (Phila Pa 1976). 2005;30(7):798-806. 26. Ozgen S, Konya D, Toktas OZ, Dagcinar A, Ozek MM. Lumbar disc herniation in adolescence. Pediatr Neurosurg. 2007;43(2):77-81. 27. Garg S, Dormans JP. Tumors and tumor-like conditions of the spine in children. J Am Acad Orthop Surg. 2005;13(6):372-381. 28. Huisman TA. Pediatric tumors of the spine (...) A. Nonspondylolytic etiologies of lumbar pain in the young athlete. Curr Sports Med Rep. 2006;5(1):44-49. 32. Wang H, Cheng J, Xiao H, Li C, Zhou Y. Adolescent lumbar disc herniation: experience from a large minimally invasive treatment centre for lumbar degenerative disease in Chongqing, China. Clin Neurol Neurosurg. 2013;115(8):1415-1419. 33. Vendhan K, Sen D, Fisher C, Ioannou Y, Hall-Craggs MA. Inflammatory changes of the lumbar spine in children and adolescents with enthesitis-related arthritis: magnetic

2016 American College of Radiology

180. CRACKCast E038 – Pediatric Trauma

is that it DOESN’T help you prognosticate neurological outcome (no validation) and has poor inter-rater reliability children with poor scores can have great outcomes Eyes Verbal Motor: 4 – Spontaneous 5 – appropriate cry and coo 6 – normal spontaneous movement 3 – To voice 4 – irritable cry 5 – withdraws to touch 2 – To Pain 3 – inconsolable cry 4 – withdraws to pain 1 – Unresponsive 2 – grunts 3 – flexion to pain 1 – no verbal response 2 – extension to pain 1 – no motor response Signs of herniation might (...) doctrine as ICP increases – brain perfusion/ability to autoregulate decreases herniation syndromes: uncal herniation unilaterally dilated pupil compression of ipsilateral third nerve, contralateral hemiplegia, hyperventilation “down and out pupil” may progress to frank apnea and cardiac arrest Treatment: **prophylactic treatment with anticonvulsants not recommended ** incidence of post-traumatic seizures is low treatment of increased ICP: non-pharmacologic methods and pharmacologic methods 1) non

2016 CandiEM

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