Author: Murat Yazici, Turkey

Acromioclavicular Joint Injuries Illustrations

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Acromioclavicular joint (AC) injuries are associated with damage to the joint and surrounding structures.

ANATOMY

The acromioclavicular joint, together with the sternoclavicular joint, connects the upper limb to the skeleton.

The support of the acromioclavicular joint is provided by the ligament and muscle surrounding the joint. The capsule surrounding the acromioclavicular joint is strengthened by the acromioclavicular ligaments. The joints are acromioclavicular ligaments that provide horizontal stability.

The coracoclavicular ligaments consist of two parts, the lateral trapezoid, and the medial conoid, and connect the distal lower clavicle to the coracoid process of the scapula. The coracoclavicular ligament is the main stabilizing ligament of the upper limb.

Acromioclavicular joint injuries occur at all ages, but are most common in the 20-40 year age group, 5x times more common in men than women. It is a common contact sports injury in young male athletes (1).

There are two main mechanisms of acromioclavicular joint injury; direct and indirect (2). A direct blow or fall to the shoulder results in a superior force on the acromion with restricted clavicular movement in the joint, the acromion is forcibly pushed down and medially relative to the clavicle. It can occur indirectly as a result of a fall on the hand or elbow, causing the humerus to be pushed into the acromion, resulting in lower-grade injuries that typically protect the coracoclavicular ligament.

Imaging can be used to classify acromioclavicular injuries and is the most widely used Rockwood classification. 

ROCKWOOD CLASSIFICATION

References and Further Reading

  1. Dyan V. Flores, Paola Kuenzer Goes, Catalina Mejía Gómez et-al. Imaging of the Acromioclavicular Joint: Anatomy, Function, Pathologic Features, and Treatment. (2020) RadioGraphics. 40 (5): 1355-1382.
  2. Vanhoenacker F, Maas M, Gielen JL. Imaging of Orthopedic Sports Injuries. (2006)
  3. Tintinalli’s Emergency Medicine, A Comprehensive Study Guide 9th edition. ( 2019)

  4. Rockwood classification of acromioclavicular joint injury

  5. Acromioclavicular injury

 

Cite this article as: Murat Yazici, Turkey, "Acromioclavicular Joint Injuries Illustrations," in International Emergency Medicine Education Project, June 30, 2021, https://iem-student.org/2021/06/30/acromioclavicular-joint-injuries-illustrations/, date accessed: March 22, 2023
 

Basic ECG Illustrations

basic ecg illustrations
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ECG Basics

ECG Waves

 

Intervals and Segments

 

References and Further Reading

1. ECG Rate Interpretation 2. ECG Rhythm Evaluation 3. ECG Axis Interpretation 4. P wave 5. Q wave 6. R wave 7. T wave 8. U wave 9. PR interval 10. QT interval 11. ST Segment 12. QRS complex    
Cite this article as: Murat Yazici, Turkey, "Basic ECG Illustrations," in International Emergency Medicine Education Project, February 24, 2021, https://iem-student.org/2021/02/24/basic-ecg-illustrations/, date accessed: March 22, 2023

Recent Blog Posts by Murat Yazici

Pathological Brain CT Findings – Illustration

Pathological Brain CT Findings
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In this post, we will share the traumatic (Epidural, subdural, cerebral contusion, subarachnoid hemorrhage, cerebral edema) and atraumatic (intracranial parenchymal hemorrhage, subarachnoid hemorrhage) brain computerized tomography (CT) findings. We will also provide GIF images and one final image, which includes all pathologies in one image.

ATRAUMATIC PATHOLOGICAL BRAIN CT FINDINGS

TRAUMATIC PATHOLOGICAL BRAIN CT FINDINGS

ATRAUMATIC PATHOLOGICAL BRAIN CT FINDINGS – GIF

TRAUMATIC PATHOLOGICAL BRAIN CT FINDINGS  – GIF

PATHOLOGICAL BRAIN CT FINDINGS  – ONE POST

References and Further Reading

  1. https://iem-student.org/2019/09/04/cranial-ct-anatomy-a-simple-image-guide-for-medical-students/
  2. The Atlas of Emergency Radiology
Cite this article as: Murat Yazici, Turkey, "Pathological Brain CT Findings – Illustration," in International Emergency Medicine Education Project, November 18, 2020, https://iem-student.org/2020/11/18/pathological-brain-ct-findings-illustration/, date accessed: March 22, 2023

Rapid Ultrasound for Shock and Hypotension (RUSH) Protocol US Imaging – Illustrations

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Patients with hypotension or shock have high mortality rates, and traditional physical exam techniques can be misleading. Diagnosis and initial care must be accurate and prompt to optimize patient care. Ultrasound is ideal for evaluating critically ill patients in shock, and ACEP guidelines now delineate a new category of ultrasound (US)– “resuscitative.” Bedside US allows for direct visualization of pathology and differentiation of shock states (1). The RUSH is one of the most commonly used protocols for this purpose.

The RUSH exam involves a 3-part bedside physiologic assessment simplified as “the pump,” “the tank,” and “the pipes” (2).

Rush steps and probs
Rush pump
Rush Tank
Rush pipes

Pump

Rush pump
RUSH parasternal long axis
RUSH parasternal long axis
RUSH parasternal long axis
RUSH parasternal short axis
RUSH parasternal short axis
RUSH subcostal
RUSH apical

Tank

Rush Tank
Rush IVC
Rush intraperitoneal fluid
Rush intraperitoneal fluid
Rush intraperitoneal fluid
Rush lung
Rush lung

Pipes

Rush pipes
Rush pipes
Rush pipes
Rush pipes

References and Further Reading

  1. By Organ System or Specialty Archives | Page 84 of 123 | ALiEM. https://www.aliem.com/category/emergency-medicine-clinical/system/page/84/
  2. Seif D1, Perera P, Mailhot T, Riley D, Mandavia D. “Bedside ultrasound in resuscitation and the rapid ultrasound in shock protocol” Crit Care Res Pract. 2012;2012:503254.
  3. https://iem-student.org/2020/02/14/lower-extremity-deep-venous-us-imaging-illustrations/
  4. https://iem-student.org/rush/
  5. https://iem-student.org/efast/
Cite this article as: Murat Yazici, Turkey, "Rapid Ultrasound for Shock and Hypotension (RUSH) Protocol US Imaging – Illustrations," in International Emergency Medicine Education Project, May 29, 2020, https://iem-student.org/2020/05/29/rush-protocol-illustrations/, date accessed: March 22, 2023

Lower Extremity Deep Venous US Imaging – Illustrations

lower extremity us illustrations
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Ultrasound evaluation for deep venous thrombosis (DVT) is one of the 11 core ultrasound applications for emergency physicians as listed in the 2008 American College of Emergency Physicians guidelines (1). Because ultrasound applications started to be implemented into medical school curriculum in many countries, learning basic ultrasound applications as early as possible will benefit medical students and junior residents. In this post, I will share lower extremity venous ultrasound illustrations with you. 

Indications

The clinical indications for performing a lower venous ultrasound examination is the suspicion of a lower extremity DVT in a swollen or discoloured leg. 

Transducer

Select a high-frequency linear transducer, (5-10) MHz transducer since it provides optimal venous copmression and image resolution.

lower extremity venous ultrasound - linear transducer

Remember Risk Factors of DVT

  • Age > 60
  • Cancer
  • Central venous catheter/insertion
  • Genetic causes of hypercoagulopaty
  • History of DVT
  • Immobilization
  • Obesity
  • Pregnancy
  • Smoking
  • Trauma or recent surgery
  • Use of birth control pills or hormone replacement therapy

Wells Score for Deep Vein Thrombosis

CriteriaScore
Active cancer(treatment ongoing or within previous 6 months or palliative treatment)
1
Paralysis, paresis, or recent plaster immobilization or of the lower extremities1
Recently bedridden for 3 days or more or major surgery within the previous 12 weeks requiring general or regional anesthesia1
Localized tenderness along the distribution of the deep venous system1
Entire leg swollen1
Calf swelling > 3cm compared to asymptomatic leg (measuring 10 cm below tibial tuberosity)1
Pitting edema confined to the symptomatic leg1
Non varicose collateral superficial veins1
Previously documented DVT1
Alternative diagnosis at least as likely as DVT1
DVT evaluation algorithm
Select a high-frequency linear transducer, (5-10) MHz transducer since it provides optimal venous copmression and image resolution.
sectional anatomy of lower extremity veins

Normal DVT Ultrasound Findings

normaL DVT ULTRASOUND findings
normaL DVT ULTRASOUND findings
normaL DVT ULTRASOUND findings
normaL DVT ULTRASOUND findings
normaL DVT ULTRASOUND findings

Reference and Further Reading

  1. American College of Emergency Physicians. Emergency ultrasound guidelines 2008. http://www.acep.org/WorkArea/DownloadAsset.aspx?ID=32878. February 2012.

Note: Visual drawings are inspired by the Point-of-Care ULTRASOUND Book.

Cite this article as: Murat Yazici, Turkey, "Lower Extremity Deep Venous US Imaging – Illustrations," in International Emergency Medicine Education Project, February 14, 2020, https://iem-student.org/2020/02/14/lower-extremity-deep-venous-us-imaging-illustrations/, date accessed: March 22, 2023

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Hepatobiliary US Imaging – Illustrations

hepatobiliary ultrasound
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Anatomy Of The Hepatobiliary System

Anatomy of the hepatobiliary system

Indications

Indications for clinicians to perform point-of-care hepatobiliary ultrasound include the evaluation of; abdominal pain, jaundice, sepsis and ascites.

Transducer

The most commonly used positions include; left lateral decubitus and supine position. A low-to medium-frequency (2–5 MHz) curvilinear ultrasound transducer will suffice for most ultrasound examinations of the gallbladder.

curvilinear transducer

Patient positioning

Patient positioning plays a vital role in the hepatobiliary ultrasound examination. Transducer position according to gallbladder; longitudinal and transverse.

Focus Points on Hepatobilary Ultrasound

focus points hepatobilary ultrasound

Patient Position and Transducer Position

Patient Position and Transducer Position​
Patient Position and Transducer Position​

Normal Hepatobiliary Ultrasound Findings

Normal Hepatobiliary Ultrasound Findings​

Pathological Hepatobiliary Ultrasound Findings

Pathological Hepatobiliary Ultrasound Findings
Pathological Hepatobiliary Ultrasound Findings
Pathological Hepatobiliary Ultrasound Findings
Pathological Hepatobiliary Ultrasound Findings
Cite this article as: Murat Yazici, Turkey, "Hepatobiliary US Imaging – Illustrations," in International Emergency Medicine Education Project, November 27, 2019, https://iem-student.org/2019/11/27/hepatobiliary-us-imaging-illustrations/, date accessed: March 22, 2023

Cranial CT Anatomy: A simple image guide for medical students

cranial ct anatomy
~ Murat Yazici, Turkey ~ Leave a comment

Computed tomography (CT) is the most useful brain imaging tool in emergency medical practice. It is also the first imaging modality in patients presenting to the emergency department with headache, stroke and head trauma.

Many cranial lesions can easily be recognized in CT. One of the key points of diagnosing cranial lesions is knowing the anatomical structures. This gives us the advantage to evaluate CT by combining clinical findings with the image.

We created an image series for the most essential eight anatomical structures.

cranial CT slices

Centrum Semiovale

centrum semiovale

Lateral Ventricles

lateral ventricles

3rd Ventricle, Basal Ganglia, Superior Cerebellar Cistern

3rd Ventricle, Basal Ganglia, Superior Cerebellar Cistern​

3rd Ventricle, Basal Ganglia, Quadrigeminal Plate

3rd Ventricle, Basal Ganglia, Quadrigeminal Plate

Midbrain, Interpeduncular Cistern​

interventricular cistern

Suprasellar Cistern, 4th Ventricle

Suprasellar cistern, 4th ventricle

Sella Turcica

sella turcica

Pons, Medullary Junction

pons medullary junction

Further Reading

Bonus Infographic

Cite this article as: Murat Yazici, Turkey, "Cranial CT Anatomy: A simple image guide for medical students," in International Emergency Medicine Education Project, September 4, 2019, https://iem-student.org/2019/09/04/cranial-ct-anatomy-a-simple-image-guide-for-medical-students/, date accessed: March 22, 2023

Basic Transthoracic Echocardiographic Imaging

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In the adult transthoracic echocardiographic (TTE) imaging, a standard series of cross-sectional anatomical views are recommended by the American Society of Echocardiography (ASE).

There are two major obstacles for ultrasound beam transmission: 1) bony chest wall, 2) air-filled lungs. Specific ultrasound transducer positions on the chest wall are required in order to perform optimal examination.

Four primary transducer positions or “windows” are recommended. For patients with normal levocardia, the examination begins at (1) the left parasternal window, followed by the apical window, (3) the subcostal or subxiphoid window, and (4) the suprasternal notch window

A4C(Apical Four Chamber), A5C(Apical Five Chamber), A2C(Apical Tho Chmaber), A3C(Apical Three Chamber)

In this blog post, I will try to explain the “windows” of the echocardiographic imaging through drawings

LA(Left Atrium), LV(Left Ventricle), LVOT(Left Ventricular Outflow Tract), Ao(Aorta), RV(Right Ventricle), MV(Mitral valve), AoV(Aortic valve)
LV(Left Ventricle), RV(Right Ventricle)
LA(Left Atrium), RA(Right Atrium), RV(Rigt Ventricle), RVOT(Right Ventricular Outflow Tract), AoV(Aortic Valve), TV(Tricuspid Valve), PV(Pulmonary Valve)
LA(Left Atrium), RA(Right Atrium), RV(Right Ventricle), LV(Left Ventricle), LVOT(Left Ventricular Outflow Tract), TV(Tricuspid Valve), MV(Mitral Valve), AoV(Aortic Valve)
LA(Left Atrium), RA(Right Atrium), RV(Right Ventricle), LV(Left Ventricle), LVOT(Left Ventricular Outflow Tract), TV(Tricuspid Valve), MV(Mitral Valve), AoV(Aortic Valve)
LA(Left Atrium), LV(Left Ventricle), MV(Mitral Valve)
LA(Left Atrium), LV(Left Ventricle), Ao(Aorta), MV(Mitral Valve), AoV(Aortic Valve)
LA(Left Atrium), RA(Right Atrium), LV(Left Ventricle), RV(Right Ventricle), MV(Mitral Valve), TV(Tricuspid Valve)
LA(Left Atrium), BCA(Brachiocephalic Artery), LCA(Left Common Carotid Artery), LSC(Left Subclavian Artery), RPA(Right Pulmonary Artery)
Cite this article as: Murat Yazici, Turkey, "Basic Transthoracic Echocardiographic Imaging," in International Emergency Medicine Education Project, June 12, 2019, https://iem-student.org/2019/06/12/basic-transthoracic-echocardiographic-imaging/, date accessed: March 22, 2023