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doctor poetry

The Doctor (Poetry)


Behind the white coat
Under the bell of stethoscope
Beats a heart like yours
Behind the eyes without tears
Under the weary head
Are the words unsaid
Blunted response to your pain
Habituation much but a bit feigned
A serious resting look on …

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Superficial Cervical Plexus Block : Mnemonic


This is a visual mnemonic for the nerve arrangement of superficial cervical cutaneous branches of cervical plexus. This mnemonic was created only for the ease to remember and may not resemble exact anatomy.

Superficial Cervical plexus

The site of injection for superior cervical plexus nerve block is the midpoint of posterior border of sternocleidomastoid. Assuming this as a center point, the various position of nerves, from north going anti-clockwise is given by mnemonic “GLAST”:

  1. 1 o’ clock: Greater auricular nerve (C2,C3) – Innervates skin over the parotid gland, angle of jaw and posterior ear
  2. 11 o’ clock: Lesser occipital nerve (C2) – Innervates scalp behind and above ear
  3. 7 o’ clock: Spinal accessory nerve (XI) – This doesn’t belong to superficial cervical plexus and lies deep to the sternocleidomastoid muscle and innervates sternocleidomastoid and trapezius
  4. 6 o’ clock: Supraclavicular nerve (C3,C4) – Divides into medial, intermediate and lateral branches and supply sensation over shoulder, lateral neck and anterior upper thoracic wall
  5. 3 o’ clock: Transverse cervical nerve (C2, C3) – Innervates skin of front and side of neck (anterior triangle)

All these nerves are also the contents of the occipital triangle of neck. Except spinal accessory nerve, all these nerves crosses superficial to the sternoclediomastoid muscle. In general, the superficial cervical plexus supply the skin of anterolateral neck. Superficial cervical plexus block is indicated for skin surgeries of head and neck.

Origin of cervical plexus: anterior rami of the C1 – C4 nerve roots

Location of cervical plexus: anterior to the cervical vertebrae and posterior to the sternocleidomastoid muscle.

Components of cervical plexus:

  1. Cutaneous branches, which supply the lesser occipital, greater auricular, transverse cervical, and supraclavicular nerves
  2. Ansa cervicalis, which innervates the infrahyoid and geniohyoid muscles
  3. Phrenic nerve, which is the only motor nerve to innervate the diaphragm
  4. Contributions to the accessory nerve (CN XI), which innervates the sternocleidomastoid and trapezius muscles
  5. Direct muscular branches, which supply prevertebral muscles of the neck.


Insert the needle ( 22-gauge, 5-cm, short bevel needle) at the midpoint of the posterior border of the sternocleido – mastoid muscle to approximately half the depth of the muscle, and inject 3 to 4 mL of local anesthetic. Also perform a subcutaneous injection of additional local anesthetic cephalad and caudad along the length of the sternocleidomastoid muscle posterior border.

Muscles of forearm : Quick review

posterior compartment of forearm

A) Superficial flexors:
Common flexor origin: Medial epicondyle
Nerve supply: Median nerve except Flexor carpi ulnaris which is also supplied by ulnar nerve

Nerve Supply

Pronator teres
Mid-lateral radius
Flex forearm
Median  nerve

Flexor carpi raialis
2nd and 3rd metacarpal bones
Flex wrist
Median nerve

Palmaris longus
Palmar …

Febrile Seizure : Clinical approach

Febrile seizure anticonvulsants

A) General consideration:
Febrile seizures are seizures during fever occuring between 6 months and 5 years of age in absence of:

CNS infections
Abnormal neurologic findings

Types of febrile seizure:

Simple febrile seizure:

Brief (< 15 minutes)
Within 24 hours of onset …

Nutritional History Made Easy

nutritional history

Energy Requirement
1. For a child with normal body weight:

100 Kcal/kg for 1st 10 kg
Add 50 Kcal/kg for next 10 kg
Add 20 Kcal/kg for body weight additional to 20 kgs

2. By age:

For ≤ 1 year: 100 …

Acute Diarrhea – Approach

ORS acute diarrhea

There is no standard definition of diarrhea. Diarrhea may be defined with one or combination of the following criterion:

Change in consistency of stool: Increased water-content
Increase in freqency of stool: >3 times per day
Increase in weight …