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23/04/2026
Anatomy
7 injections that should NEVER be pushed rapidly (IV push) because they can cause serious complications. 1. Potassium Chloride (KCl) Why not IV push? Rapid potassium can cause fatal arrhythmias and cardiac arrest. Correct way: • Always dilute in IV fluid • Infusion pump recommended • Usually 10–20 mEq/hour � Remember: IV push potassium = cardiac arrest risk. 2. Calcium Gluconate Why not fast push? Rapid administration may cause arrhythmia, hypotension, and tissue necrosis if extravasation occurs. Correct way: • Slow IV injection (5–10 min) • Monitor ECG 3. Noradrenaline (Norepinephrine) Why not IV push? Rapid bolus can cause severe hypertension, arrhythmia, and tissue necrosis. Correct way: • Diluted infusion via syringe pump • Prefer central line 4. Magnesium Sulphate Why not rapid push? Fast injection can cause hypotension, respiratory depression, and cardiac arrest. Correct way: • Give slow IV over 10–20 minutes 5. Amiodarone Why not IV push? Rapid bolus can cause severe hypotension and bradycardia. Correct way: • Diluted infusion • Example: 150 mg over 10 min (ACLS) 6. Sodium Bicarbonate Why avoid rapid push? Can cause alkalosis, electrolyte imbalance, and tissue damage. Correct way: • Give slow IV and only when indicated (e.g., severe acidosis, hyperkalemia) 7. Furosemide (Frusemide) Why not fast push? Rapid administration may cause ototoxicity and severe hypotension. Correct way: • Slow IV injection (≤20 mg/min) �
20/02/2026
💪🦴 Muscles of the Back – The Body’s Structural Support and Movers
The back muscles are a complex network that provides posture, spinal movement, and upper limb mobility, while protecting the spinal cord. They are arranged in layers and divided into extrinsic (superficial & intermediate) and intrinsic (deep) muscles.
🔹 Extrinsic (Superficial & Intermediate) Back Muscles
These muscles connect the upper limbs and ribs to the spine, mainly involved in movement and respiration.
Superficial Group (Upper limb movement)
• Trapezius – elevates, retracts, and rotates the scapula
• Latissimus dorsi – extends, adducts, and medially rotates the arm
• Rhomboid major & minor – retract and stabilize the scapula
• Levator scapulae – elevates the scapula
Intermediate Group (Respiration)
• Serratus posterior superior – elevates ribs
• Serratus posterior inferior – depresses ribs
🔹 Intrinsic (Deep) Back Muscles
Also called true back muscles, these muscles maintain posture and move the vertebral column.
Superficial Intrinsic Layer
• Splenius capitis – extends head and neck
• Splenius cervicis – rotates and extends neck
Intermediate Layer – Erector Spinae Group
Powerful extensors of the spine, including:
• Iliocostalis – lateral column
• Longissimus – intermediate column
• Spinalis – medial column
Function: posture maintenance and bending movements
Deep Layer – Transversospinalis Group
• Semispinalis – extends vertebral column and head
• Multifidus – stabilizes vertebrae
• Rotatores – assist rotation of spine
🧠 Nerve Supply
All intrinsic muscles are supplied by posterior (dorsal) rami of spinal nerves.
⚡ Functions
✔ Maintain upright posture
✔ Facilitate movements: flexion, extension, rotation, lateral bending
✔ Stabilize vertebrae during motion
✔ Assist respiration (intermediate group)
⚕️ Clinical Importance
• Weak or atrophied back muscles → poor posture, low back pain
• Muscle spasm → restricted spinal mobility
• Injury can affect upper limb movement and stability
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