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Supraclavicular Murmur

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21. Penetrating Chest Trauma (Treatment)

for control and repair of the injury is of prime importance. A median sternotomy with supraclavicular extensions for access to the subclavian vessels is the most useful incision. A posterolateral thoracotomy is the incision of choice for access to the descending thoracic aorta. The trapdoor, or book, incision is of purely historical significance. Operative repair of thoracic aortic injuries is virtually always possible by means of lateral aortorrhaphy with extremely short cross-clamp times. Rarely (...) more distal embolization that may occur during positioning. Asymptomatic patients with small distal fragments may be treated expectantly. Occasionally, missile emboli may migrate through a patent foramen ovale or from central parenchymal or vascular injuries to gain access to the left side of the heart and then to the systemic circulation. Cardiovascular fistulae Most cardiovascular arterial-to-venous fistulae occur following stab wounds. Virtually all manifest as a machinery murmur after

2014 eMedicine Surgery

22. Penetrating Chest Trauma (Follow-up)

for control and repair of the injury is of prime importance. A median sternotomy with supraclavicular extensions for access to the subclavian vessels is the most useful incision. A posterolateral thoracotomy is the incision of choice for access to the descending thoracic aorta. The trapdoor, or book, incision is of purely historical significance. Operative repair of thoracic aortic injuries is virtually always possible by means of lateral aortorrhaphy with extremely short cross-clamp times. Rarely (...) more distal embolization that may occur during positioning. Asymptomatic patients with small distal fragments may be treated expectantly. Occasionally, missile emboli may migrate through a patent foramen ovale or from central parenchymal or vascular injuries to gain access to the left side of the heart and then to the systemic circulation. Cardiovascular fistulae Most cardiovascular arterial-to-venous fistulae occur following stab wounds. Virtually all manifest as a machinery murmur after

2014 eMedicine Surgery

23. Thoracic Trauma (Overview)

hypertension, interscapular murmurs, and diminished or absent pulses in upper or lower extremities are common physical signs. Aortography is the diagnostic procedure of choice if the child is stable (see the image below). Computed tomography scanning is an alternative in that it can be rapidly performed in concert with imaging of the brain, abdomen, and pelvis. Lateral aortograph shows a tear at the level of the ligamentum arteriosum. If the child is stable, aortography is the procedure of choice (...) for 24 hours after injury. Echocardiography is required for any new onset of a murmur. Repair is indicated if ischemia and myocardial dysfunction are severe and salvageable myocardium is found. Most patients with rupture of the myocardium do not reach the hospital alive. However, the injury is occasionally contained by the pericardium, and the child presents in shock from a combination of hemorrhage and cardiac tamponade. [ ] . The mechanism of injury is likely sudden severe compression of the chest

2014 eMedicine Pediatrics

24. Allergic and Environmental Asthma (Treatment)

laryngeal abnormality, although VCD can be present without a localizing wheeze. Increased jugular venous distension may point to an alternative explanation, such as , for the patient’s dyspnea and wheezing. Similarly, palpation of cervical or supraclavicular adenopathy would suggest malignancy, , or infection. Cardiovascular system Findings are normal. Patients with status asthmaticus may have a pulsus paradoxus greater than 10 mm Hg. A murmur, S3 gallop, or rub suggests a cardiac problem and not asthma

2014 eMedicine.com

25. Aortic Stenosis

sound (best heard at aortic area) Moderate Aortic Stenosis Ejection click (best heard at apex) Early (loudest at right second intercostal space) Transmitted to Supraclavicular, Carotids, Apex Harsh Systolic ejection murmur that peaks later in systole Ends well before A2 heart sound altered Upstroke of the pulse has shudder Delayed, prolonged, low-volume carotid pulsation ( ) 70% and 98% in Aortic Stenosis Apex impulse may be abnormal, accentuated Slightly sustained Presystolic ("a wave") precedes (...) : and in response to V. Symptoms Mild to Moderate stenosis Asymptomatic Severe Obstruction (most common presenting symptom) on exertion progresses to at rest Other presenting symptoms induced VI. Signs Classic Murmur Harsh, late-peaking, crescendo-decrescendo Medium pitch Heard best at right upper (second intercostal space) May also be heard at apex (esp. elderly) May radiate into region Mild Aortic Stenosis Loud ejection click (best heard at apex) Short, early (at right second intercostal space) Loud A2 heart

2015 FP Notebook

26. Hemoptysis

and exit, symmetry of breath sounds, and presence of crackles, rhonchi, stridor, and wheezing. Signs of consolidation (eg, egophony, dullness to percussion) should be sought. The cervical and supraclavicular areas should be inspected and palpated for lymphadenopathy (suggesting cancer or TB). Neck veins should be inspected for distention, and the legs and presacral area should be palpated for pitting edema (suggesting heart failure). Heart sounds should be auscultated with notation of any extra heart (...) sounds or murmur that might support a diagnosis of heart failure and elevated pulmonary pressure. The abdominal examination should focus on signs of hepatic congestion or masses, which could suggest either cancer or hematemesis from potential esophageal varices. The skin and mucous membranes should be examined for ecchymoses, petechiae, telangiectasia, gingivitis, or evidence of bleeding from the oral or nasal mucosa. If the patient can reproduce hemoptysis during examination, the color and amount

2013 Merck Manual (19th Edition)

27. Dyspnea

) Auscultation Chest x-ray BNP measurement Echocardiography Papillary muscle dysfunction or rupture Sudden onset of chest pain, new or loud holosystolic murmur, and signs of heart failure, particularly in patients with recent MI Auscultation Echocardiography Other causes Anxiety disorder causing hyperventilation Situational dyspnea often accompanied by psychomotor agitation and paresthesias in the fingers or around the mouth Normal examination findings and pulse oximetry measurements Clinical evaluation (...) Auscultation Chest x-ray Echocardiography Loud S 2 , parasternal heave, murmur of triscuspid regurgitation Echocardiography Right heart catheterization Stable or Substernal chest pressure with or without radiation to the arm or jaw, often provoked by physical exertion, particularly in patients with risk factors for CAD ECG Cardiac stress testing Sometimes cardiac catheterization Other causes Dyspnea on exertion progressing to dyspnea at rest Normal lung examination and pulse oximetry measurement Sometimes

2013 Merck Manual (19th Edition)

28. Neurological History and Examination

at the angle of the jaw for carotid bruits. Listen over the supraclavicular fossa for vertebral or subclavian bruits. A common carotid bruit may be heard by listening between these two sites. Listen with the bell of the stethoscope over a closed eyelid for bruits due to cerebral arteriovenous malformations. Listen for cardiac murmurs to ensure that any bruit heard is not just due to transmission of these. Note that just because a bruit is not heard, it does not mean that there is no significant stenosis (...) in cervical spinal cord sensory tracts (seen in, for example, multiple sclerosis, syringomyelia, tumours) . Is there any neck stiffness? This can be a sign of meningeal irritation. The chin can normally touch the chest when the neck is flexed but this is not possible if neck stiffness is present. This may be a sign of meningitis or subarachnoid haemorrhage. Palpate the supraclavicular fossae: Look for enlarged lymph nodes or cervical ribs. Listen for any bruits: Listen at the carotid bifurcation

2008 Mentor

29. Haemoptysis (PubMed)

a cardiovascular examination. Significant signs may include: The diastolic murmur of mitral stenosis. Signs of LVF. Tachypnoea, tachycardia, fixed split S2, pleural rub, and unilateral leg pain or swelling which may indicate thromboembolic disease. Lung signs that may be found with haemoptysis include: Fine inspiratory rales (associated with alveolar blood). Inspiratory and expiratory rhonchi (associated with airway secretions and blood). Look for evidence of an exacerbation of or lower respiratory tract (...) infection. Unilateral wheeze and distal consolidation raise the suspicion of endobronchial tumour. Unilateral wheeze or stridor may also indicate the presence of a foreign body. With apical dullness and cachexia, should be considered. Digital clubbing can reflect chronic lung disease ( , , ). Supraclavicular lymphadenopathy, , , , hyperpigmentation, and may be associated with malignancy. Investigations Bronchoscopy combined with imaging technology usually identifies the bleeding site in the lungs

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2008 Mentor

30. Still's Murmur

murmur Upper left sternal border, mid-systolic, grade 1-3, grating PS, ASD Venous hum Right and/or left infraclavicular, continuous, only heard in upright position, diastolic component louder than systolic PDA Carotid bruit (supraclavicular systolic murmur) Supraclavicular area, ejection systolic, grade 2-3 AS Peripheral pulmonary stenosis (pulmonary flow murmur of newborn) Upper left sternal border, grade 1-2, radiates to axillae and back, usually disappears by 6 months of age PS Neonatal heart (...) Still's Murmur Heart Murmurs in Children. What is a heart murmer? | Patient TOPICS Try our Symptom Checker TREATMENT RESOURCES Try our Symptom Checker PROFESSIONAL Upgrade to Patient Pro / / Search Heart Murmurs in Children Authored by , Reviewed by | Last edited 25 Apr 2014 | Certified by This article is for Medical Professionals Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based on research evidence, UK and European

2008 Mentor

31. Heart Murmurs in Children

murmur Upper left sternal border, mid-systolic, grade 1-3, grating PS, ASD Venous hum Right and/or left infraclavicular, continuous, only heard in upright position, diastolic component louder than systolic PDA Carotid bruit (supraclavicular systolic murmur) Supraclavicular area, ejection systolic, grade 2-3 AS Peripheral pulmonary stenosis (pulmonary flow murmur of newborn) Upper left sternal border, grade 1-2, radiates to axillae and back, usually disappears by 6 months of age PS Neonatal heart (...) Heart Murmurs in Children Heart Murmurs in Children. What is a heart murmer? | Patient TOPICS Try our Symptom Checker TREATMENT RESOURCES Try our Symptom Checker PROFESSIONAL Upgrade to Patient Pro / / Search Heart Murmurs in Children Authored by , Reviewed by | Last edited 25 Apr 2014 | Certified by This article is for Medical Professionals Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based on research evidence, UK

2008 Mentor

32. Cardiac Murmurs in Childhood (PubMed)

the hum, and supraclavicular arterial murmurs from carotid artery bruit, aortic stenosis and coarctation by similar maneuvers and blood pressure recordings. The article outlines the points of differentiation in order to arrive at a firm diagnosis and obviate concern and unnecessary referrals. (...) Cardiac Murmurs in Childhood Innocent heart murmurs can be identified and distinguished from organic murmurs using only clinical skills. Pulmonary flow murmurs may be differentiated from those of atrial septal defect or pulmonary stenosis by the behavior of the second heart sound, parasternal vibratory murmurs from ventricular septal defect, aortic stenosis and mitral regurgitation by their length and radiation, venous hums from patent ductus arteriosus by maneuvers designed to obliterate

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1981 Canadian Family Physician

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