Algorithm for the Evaluation of Dysphagia:Oropharyngeal: - Characterized by difficulty initiating swallowing and accompanied by choking/coughing, nasopharyngeal regurgitation or aspiration. - Involved anatomy: Tongue, muscles of mastication, soft palate (elevation to close nasopharynx), suprahyoid muscles (elevate larynx), epiglottis (occlude airway), cricopharyngeus muscle (release upper esophageal sphincter). Neurological control predominantly coordinated by cranial nerves (V, VII, IX, X, XII) Esophageal: - Delayed after initiating swallowing and characterized by a sensation of food bolus arresting in transit. Involved anatomy: Skeletal and smooth muscle along the esophagus and lower esophageal sphincter. Neurological control predominantly coordinated by medulla #Diagnosis #Differential #EM #GI #Dysphagia #Oropharyngeal #Esophageal #Neuromuscular #Anatomic #Intraluminal #Extraluminal #Algorithm #Differential #Ddxof

Dysphagia - Differential Diagnosis Algorithm Oropharyngeal Dysphagia Esophageal Dysphagia • Upper 2/3 (striated muscle): stroke, NMJ disorders, ALS, MS, muscular dystrophy, spinal muscular atrophy, SLE, Sjogren, web • Mid esophagus: pill esophagitis • Lower 2/3 (smooth muscle): scleroderma, MCTD, achalasia. strictures, adenocarcinoma, DES, schatzki Entire length: RA. inflammatory myopathies Matthew Ho, MD PhD @MatthewHoMD #Dysphagia #Differential #Diagnosis #Algorithm #Oropharyngeal #Esophageal #gastroenterology

Hyperkalemia management algorithm 2023-2024 based on UKKA and KDIGO guidelines. #hyperkalemia #electrolytes #algorithm #emergency #management Notes: (1) Up to half of hyperkalemia patients have a normal ECG including some patients with extreme hyperkalemia. A normal ECG doesn't mean it should no longer be monitored (2) While most patients are asymptomatic, it's important to pay attention to clinical manifestations such as muscle weakness and paresthesias (3) I've added a potassium lowering drug (sodium zirconium cyclosilicate) (4) Due to high % of hypoglycemia, monitoring glucose every 30-60 mins is advised and 50g glucose over 5 hours in patients with < 126 mEq/dL is also administered (5) Many algorithms include 10ml of calcium gluconate but recent UKKA, 2023 guidelines advice 30ml (effective 6.8 mmol calcium) (6) Dialysis must be done in hemodialysis patients with potassium levels of 6.5 mEq. Otherwise for refractory hyperkalemia

Medial Thigh Muscles Anatomy By @rev.med #Medial #Thigh #Muscles #Anatomy #MSK #orthopedics

Hand Arthritides - Differential Diagnosis by Location and Features The Painful Hand! Wish I would’ve thought of making this prior to my first MSK rotation. Super helpful for keeping the various arthritides straight. Cynthia Czawlytko, MD @drcyncity #Hand #Arthritides #Arthritis #Differential #Diagnosis #Location #MSK #Radiology #Map

Knee Examination Right Knee - Examination maneuvers include the Lachman (ACL), anterior drawer (ACL), Lateral pivot shift, Apley compression (meniscal integrity) and McMurray (meniscal integrity) tests. #Diagnosis #Sports #Knee #PhysicalExam #Lachman #Apley #McMurray #Drawer #Test #msk

Aplastic Anemia Summary • Definition • Pathophysiology • DDx: AA vs Hypocellular MDS • Expectation • Rx Algorithm • Relapse and Refractory Zhuoer Xie, MD @ZhuoerXie #Aplastic #Anemia #diagnosis #oncology #hematololgy

Respiratory Distress Through the Years. #differential #flowchart #causes #algorithm #pulmonary #respiratory #distress #neonatal #pediatric #adult #ddxof

Peri-operative Hyperthermia - Guidelines for Crises in Anaesthesia If prolonged or ≥ 39 C this is a clinical emergency: permanent organ dysfunction and death can result. Treatment depends on the aetiology. Distinguish early between: • Excessive heating (most common) • Inadequate dissipation of metabolic heat • Excessive heat production • Actively maintained fever CAUSES OF HYPERTHERMIA COMMON • Excessive insulation, high ambient temperature, external warming devices, especially infants and children (most common) • Surgical devices, e.g. HIFU, diathermy, radiotherapy • Prolonged epidural anaesthesia • Sepsis (→ 3-14) e.g. during manipulation of a urological device • Blood transfusion • Allergic reaction / anaphylaxis (→ 3-1) Drug induced: • Neuroleptic malignant syndrome (e.g. haloperidol and other antipsychotics) • Malignant hyperthermia crisis (late sign) (→ 3-8) • Serotonin syndrome (cocaine, amphetamine, phencyclidine, MDMA) • Anticholinergic syndrome (tricyclic antidepressants, antipsychotics, antihistamines) • Sympathomimetic syndrome (cocaine, MDMA, amphetamines) Toxic: • Radiologic contrast neurotoxicity • Alcohol withdrawal Endocrine: • Thyrotoxicosis • Phaeochromocytoma Neurologic: • Meningitis • Intracranial blood • Hypoxic encephalopathy • Traumatic brain injury By Association of Anaesthetists @ https://twitter.com/AAGBI Quick Reference Handbook - Guidelines for crises in anaesthesia #Perioperative #Hyperthermia #Differential #Causes #Anesthesiology #Anesthesia #Checklist #Diagnosis #Management #Workup

Mains Electricity Failure - Guidelines for Crises in Anaesthesia Unexpected total power failure is rare and unpredictable. Ability to safely deliver and maintain anaesthesia is immediately compromised. ❶ Call for help – extra staff to monitor patient and source additional equipment. ❷ Liaise with local coordinator to activate appropriate local plan (Box A): • If immediate evacuation necessary → 4-3 ❸ Get additional light into theatre (Box B). ❹ Ensure ventilation continues: • Manual ventilation if required. • Consider moving to spontaneous ventilation. • Maintain anaesthesia. ❺ Check the pulse and blood pressure manually if monitors have failed. ❻ Check mains oxygen supply intact. If failed → 4-1 ❼ Unplug unnecessary equipment. Use correct socket for essential equipment (Box C). ❽ Assess reliability of power supply, duration of surgery and patient condition: • Consider stopping surgery immediately. • Consider continuing surgery until patient is stable and wound is closed (may be temporary closure). • Consider evacuation to theatre with intact mains supply → 4-3 ❾ Prepare recovery facilities. Consider theatres, recovery, ICU. By Association of Anaesthetists @ https://twitter.com/AAGBI Quick Reference Handbook - Guidelines for crises in anaesthesia #PowerSupply #Electricity #Failure #Anesthesiology #Anesthesia #Intraoperative #Checklist #Diagnosis #Management #Workup