Medical Images (radiography, CT, MRI, Ultrasound for Emergency Medicine) AND YOUR FINANCIAL PLAN FOR THE COMING YEARS…not related but I write about what is on my mind often so I get it said when I am thinking about it. I am not a stock advisor so do your homework but I am fully invested in every one of the stocks I have listed and I was able to get to be one of the 500 in Paul Mampilly’s even higher grossing stocks but these carry more risk but all are going up so far…You want and need to be a member of his Profits Unlimited Newsletter…it is the best newsletter for any investor above all others in my decades of investing (see below: he won the Templeton award in 2008 increasing the wealth he was given from 50 million turning it into what was over 70 million without risky investing of any kind in a stock market crash year…just type his name and you will know what that is and watch his video you need this information for many reasons immediately!) I will say this over and over. He is the world’s expert and he is giving you advice that the wealthy paid enormous amounts of money in the past. He is a gift to you. If I am the educator in emergency medicine he is the investment advisor and he is much less expensive than me…sorry but I don’t sleep to keep an army of 12,000 physicians up to speed all the time. I don’t suffer from it because I have a team of everything helping me. We have been operating silently for years due to the stalking that nearly killed me by attempts on my life…i have talked about it all over the site and i had to because it is the only way I can reenter the arena I love to explain why I had to leave for a period of time, why I did only locums and private tutoring and why I actually had to get my family out of Boca Raton for their safety. I cannot disclose my methods because although I have just restringing orders, these attacks continued. These criminals never got the money they tried to extort from me and antisocial demonic personality types like this may hold a grudge for life. So I had to keep my family from ever returning and I used methods that I am not entirely proud of but it was vital to the protection of those I cherish. I have had to live apart from all of them to keep them all safe. THIS IS NOT A JOKE. It has been so difficult at times I was always thinking of ending my life but that is something I would not do but it was a daily thought for many many years. Retraining my body to walk…and all the costs of the medication which was over $20,000.00 a year for one medication. I have learned to reduce that cost to a few thousand and you want to walk again. You can now get out of a wheel chair in some cases it was less than 1000.00 of medication. I had previously discovered the drug and I am the only physician in the world who has successfully treated all spinal cord syndromes, many forms of weakness that is “untreatable, compression neuropathies of spinal nerves who don’t want or had failed surgery…lost appetite in cancer patients, so if you suffer from any of these I will be your physician. If you know someone with any form of weakness, fatigue cord syndrome even spinal cord transection with residual function I can improve that function with a safe drug used in children and I am using much lower doses. If you wish to learn about this so you can help patients if you have a private practice I will train you. Please get the word out and have patient’s call me. They can come to me from anywhere in the world and I have gone to them on occasion. It is best if it is the otherway for me for my schedule…so 4 things here: Special Studies education, Investing in the IoT [Internet of Things], care of spinal and peripheral nerve injuries, weight loss and loss of appetite and any form of weakness, foot drop (peroneal nerve palsy) are all cured with the treatment regime I developed. I will eventually explain how I discovered this and I have helped many many people. Finally, more art! I need your support until I have employment and I will need more support to create new CME programs and get everything back up to speed. Why now? I feel safe and I have protective measures to ensure it. Unfortunately, it happened that my mother was the victim of my two brothers, and several doctors who are there friends and they did not follow anything but a course that killed my mom in a short period of time. Had I known I would have stopped them all. I could only help my sister. I feel awful and likely will for the rest of my life. But it really happened and it is just more proof that I was naive. I am now on the attack mode against all and I will not need to seek revenge. God will handle it. I just need to get back to work and stop repeating myself. I am so you know this is real…it happened and so did all the rest and I kept it hidden for years. I felt embarrassed that it happened to me. pride can work against you; I am sure you know that. You will get what you need in everyway possible because I am getting what I need and have the emotional and mental tools. I am just lacking funds but that will quickly change. Ok start reading. The website will get rid of all of this in time once we are the “machine” we were prior to all I have written about.

This webpage begins with art by Dr Collman and it will be depicted throughout the website even if it is just for your viewing enjoyment but we hope it will also inspire you and that you might find am image here you would like to own.  All of the art is for sale and our phone number is posted everywhere on the site:  561-305-8163.  Please call and leave a text message and give a best time to call so we may return you call and get you what you want!

Thirteen years of painting one image 9 feet x 2 feet this is “The Rainbow Pond, after Monet” Acrylic on Canvas this painting hung in his Boca Raton Gallery at the Embassy Suites Hotel.  It is currently in his Boca Raton Home but for sale.  It is 1000 or more hours of detailed work over a 13 year period.  His son owns in his law office one painting that is a painting of over 40,000 bruhmarks and 3 years.  It is the second time Dr Collman painted that image because the first was placed in just a display with an NFS sign.  It was for his son.  The gallery sold it to an unknown woman to Dr Collman without his permission for $3500.  So he spent two years recreating that painting and it now hangs in his son Kristopher’s Law Office.  Sorry we don’t have a photo of that image right now but it is definitely one we want you to see…with 49 layers of water thin transparent-translucent acrylic a method developed by Dr Collman to do what masters of centuries past did to make the intensity of hues pop!  However, we have some great art below before we get into the educational studies.  Enjoy and call us if you would like to own any of Dr Collman’s art.  Hundreds of paintings from the past two years exist since he was mourning the death of his mother he passed the time painting and he can be so prolific on the iPad Pro now that he has generated in a single day over 20 completed images that are all stunning…this is a feat he could never do with brush and canvas but it makes the art no less valuable because each is as good as what you see below and these are gorgeous painting with amazing subtitles of a true masterpiece of color, light, texture and so much more.  Dr Collman hopes to work with a publisher this year to put his art on everything from clothing to boxes to shoes and, of course, to wall art for your homes, offices and the like.  Enjoy.!  Yes we are attempting to raise capital.  It will cost much to get the new CME education available for you.  There is only one person creating the content, the medical illustrations and the man is so prolific and often sleeps only a few hours a night because this gives him pleasure that time is irrelevant to him.  He has his secrets to combat sleep deprivation and his Hot therapy has kept him healthy.  He does not feel the aches and pains of aging.  He has arteries from the injuries he sustained but is otherwise in great shape and can ride his bicycle 30 miles in an afternoon in S Florida.  He often drops off his rental car after he picks up his bicycle at home and then rides the 32 miles home after a locums assignment.  It is usually a 6.5 hr ride and he consumes 3.5 liters of fluid during that ride carried in a his pack.  He is lit up with the 4 from powerful beams that sw\ivel and flash, has a built in high decibel electronic horn and has both front and rear cameras which also serve as flashing red lights in addition to his tire lights.  So he is clearly visible in day light or night time and he wears full protection.  It adds weight but it is worth protection is number one in South Florida because every intersection is highly dangerous and the drivers will often disregard bike lanes, crosswalk signals and so he has to be very careful.  In Boca Raton thee are bicycle paths off of the road which are much more safe but out of boca he is either on sidewalk or in the street.  It is a risk no doubt but it keeps him exercising.  It also has saved him about 200,000.00 in the past 10 years if you add up all \the potential expenses with a nice automobile.  He will wait until there are self-driving cars before he ever considers ever purchasing a car.  Then he can keep up with other work issues and leave the driving to the car.  He believes in this technology and it has been proven to decrease automobile accidents by over 90% compared to human operators of every type of machine you can imagine a human operating or driving.  These are the companies to invest in if you are interested as they will produce over 7x as many chips in the next Three years (50 billion) which will be in automobiles, the roads and other places in the street.  They monitor everything even how wet the roads are, (so driving conditions) which cameras and onbaord chips and computers interact and do every function a human would but more efficient and with quicker reaction times.  Mbly, STM, ROK, GE, TER, IBM, NVDA, ADSK, QRVO are stocks you absolutely want to own…not tesla and aapl…theyse copanies  make the parts for these giants as well as for Google Intel, Samsung and another is QTMM which makes quantom dots  which are in the latest SAMSUNG televisions you can buy.  The are so special that they are worth more than gold per ounce…much more and when their use becomes widespread in the solar cell industry they are a penny stock that could make you an absolute fortune.  This group of stocks known as the Internet of things stocks are the next iteration of the internet connecting every device to every other device on the planet.  They allow your thermostat to talk to you smartphone already.  They will be in every device you can think of because of their abilty to do amazing mesurements and computing at the same time.  For a farmer then can tell them when is the best time to fertilize and water.  In medicine PHG is another stock (philips) which is allowing all wireless montoring and there are literally 1000s of applications of these MEMs chips.  They are also produces by other companies but these companies I have listed are smaller and have the growth potential and they have penetrated the market so well if you look at a one year stock chart on each of them you will see each is un an upward exponential or parabolic curve.  The have volatility but don’t be frightened.  That is just insiders trying to get you to sell your shares because companies like STM, GE, IBM and the whole group but most importantly QRVO an extremely valuable stock and company that is expected to be purchased.  The insiders want all of those shares as soon as that company is purchased and it will be soon, beast on the amount of insider manipulation with wide swings in the price but still heading upward than nearly all of the stocks but especially GE, QRVO, PHG, PTC have not year even treated their buy up to price.  You can increase and pay more now because most of the buyout to prices on all of these stocks is repeatedly increased because of performance.  Especially GE, IBM.  GE has its PREDIX Soft ware, and IBM has Watson and the MEMs chips produce so much data these new software giants are needed to crunch the numbers to continue to improve everything in this next generation of the internet and it is largely about efficiency, saving money while increasing growth.  Money is pouring in from the largest generation of new investors, the millenials and they have more disposable income and size in numbers that the baby boomers had….so for the next tow decades they will drive up the markets to amazing heights.  You want to own IoT type stocks.  They are set to sour 8000 percent.  It will happen in the next 4 years.  It will continue but the next four years is the early part of the adoption phase of this tech and you make the most for your investment.  There is not a single one of these stocks you should sell for any reason.  They are all going up for the next four or more years.  The stock market is expected with a DOW of 50,000 by 2020 and then going up as the millenials coniinue to buy and invest until they reach their mid 50s.  So you have the largest expected stock market run up (boom, bull market) that you will witness in the next 2 decades.  Get in now when you are young or old because in three years these stocks will mint more millionaires than in any other time in the history of the stock market.  For 100.00 a year you can buy the best newsletter on the planet, Paul Mampillys, Profits Unlimited and you can find it on the internet easily.  He has a free video explaining why MEMs is going to do what I had told you.  So if money is an issue for you, and I don’t know anyone who does not need more money, you will make more in the next three years with these stocks and it is entirely possible that a one thousand dollar investment will become over 800,000.00 in just a few short years.  I am all in.  I will keep you update but one stock has tripled its value in less than 9 months.  That is truly amazing…its STM…the largest and most diversified company with over 100,000 clients some of which are entire cities or nations who are embedding these chips in every machine, water pipe, vehicle to improve efficiency.  I suspect by the mid 2020s no more cars will be produced that are not self-driving.  You just get in and get out.  These cars will reduce MVCs by 90+ percent and more if everyone is using one. I am hoping they make them mandatory to also  eliminate  all drunk driving accidents, and accidents related to distractions like driving and using a smartphone   People will have an extra hour of time to do what ever they want when all of this in place…so it will continue to decrease the time away from pleasurable things while making everything more efficient, safe and effective.  They will be use in every industry and 19 trillon dollars of chips are expected to be installed in just the time from now to 2020…40% of that is slated for self-driving cars and every carmaker is in the market to produce these vehicles.  Audi has teemed up with Nvidia (stock symbol NVDA).  for their version of a self driving car.  All of the companies are also producing what will be the end of smart phones all together.  You need te have the inexpensive advice of this world expert, Paul Mampilly so I urge to find his video on the internet and watch it and he explains it is…it is the perfect storm for the markets to soar and that is what they are doing.  Don’t believe anyone else but this man.  Look at what he accomplished, his awards and what he is now doing for the general public at such reasonable prices.  He speaks and writes in simple logical language and he keeps his language compact so it is minimal reading. He has a weekly podcast too he will send to your email address.  I have no interest of any kind nor relationship with him other than I subscribe to his newsletter.  They will be in robots that stock shelves, they already are in stores that have no employees.  Robots don’t need breaks, a retirement account and they can work in wide temperature ranges and in the dark so 24/7, 365 days a year.  Those of you in jobs like pharmacy, retail, need to reeducate soon or you may find yourself without a job.  People like truckdrivers and all the related industries like the truck stops simply wont be needed.  All 18 wheelers will soon be driving themselves without the need for taking rest stops, computers don’t sleep.  They will be fitted with larger gas tanks I predict because that is the only reason for them to stop.  There is redundancy in these systems too and they have many types of cameras for all sorts of conditions and potential road factors a car or truck faces when driven.  Google has a test version of a car that has logged over one million miles without a single accident.  For over a decade large earth movers have been self-driving moving ore in huge machines.  Congress passed the DIGIT law to ensure this tech is going to spread throughout are nation.  The rest of the world now in large part owns a smart phone and their millenials want the same in life as ours….so we have really a global millenlial megatrend and just in the next 3 years they wil sell more chips than it took 40+ years to sell all the computers, iPads and their counterparts, and all smartphones but it will happen in just three years and you need to also multiply that number by 7 or 8.  So these companies are expected to continue to go up in performance and the portfolio is up over 30% since it began last Spring.  This just the begining of what I promised you when I recently began this website…to make your life better in everway possible.  if you can only afford to buy one share of the megastock trend’s most expensive stock buy 1 share.  I have only 20 but it makes a few hundred dollars on a regular basis:  That stock is CMG (Chipolte;s).  Hundreds of new Chipolte’s opened across the US in 2016 because it is a favorite of these people who are the largest group of spenders  So its price is high but it is going up and up.  So one more: SILVER…the recommendation is SSRI (that is the stock symbol).  Solve is widely used in the manufacture of the devices coming to you in the robots (and cobots which are collaberative robits which work with humans to do specialized tasks that human’s can’t do and yet they can do others so they work together.  Finally both European and Japanese people are sending what is called flight capital into the US because of negative interest rates.  So these folks with billions are investin in AMERICA.  Don’t believe the people on televsion paid to say tings to scare you.  Don’t have weak hands.  If one of these stocks is to be sold it will be after it goes up so much you generate enough money that now you are using “free money” to reinvest.    There is not a single stock that has a sell recommendation and they won’t for years to come.  This is easy investing and ever a 1000 dollar investment spread over all of these stocks could do wonders for your bank account in just three years.  It is real simple, MEMs chips, the Millenials and flight capital and it is going to drive the markets to highs never seen in history for more than a decade.  Essentially it will go up and Mr Mampilly shows you the history of the market when there was a boom and it is always related to these factors: population increase (people), people of spending age who will continue, i.e. the millenials, the MEMs chips, and new uses are found every month…MBLY for example has a camera for each different type of obstacle in the roads whether it is snow or a dog.  It is a total revolution in science and this is what is important.  History shows that each time there is a major tech advance combined with an increased spending population the market is in a bull mode going up.  Expect to see a DOW OF 220,000 in the next 10-12 years.  Now there are companies you might thing are going to help you but they are losers and are not in the MEMs mode the way they should.  INTEL is one of them, so Mr Mampilly has articles you can read which inform  you in 10 minutes of reading.  So you will know which stocks are not out and not part of the IoT (Internet of things) own them, and those to purchase related to the Millenials and you will be able to retire at an earlier age with much more money.  The final one for now is DATA.  They are building Data Farms all over the world to handle the enroumous amount of  MEMs

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The Original Image of “Stormy Seas” is depicted here with a light colored boarder as an example on.  You can get the original image…created on the IPAD pro with Procreate ©2017 Dwight Collman MD  We hope you will find an image you really enjoy and help support the EMedNation website and the service provided by Dr Collman to educate emergency physicians and APPs (advanced practice providers-Nurse practitioners and Physician Assistants  Call and text 561-305-8163 for more information.  Leave all of your contact information please and a best time to call you.
SUBLTLE PNEUMONIA OF LINGULA ON PORT CXR
Subtle pneumonia in the Lingula this chest film could represent many pathogens that produce such a lobar pneumonia.  More clinical information is needed to decide how to manage this patient.  For Mycoplasma, an organism without a true cell membrane which will produce coughing and wheezing for six weeks if left untreated is best treated early with a macrolide antibiotic and a ß-agonist.  Chest film findings for many forms of pneumonia but especially pneumococcal pneumonia may persist for up to one year despite resolution of the infection.  There is no role for antitussives in the treatment of pneumonia-this promotes thicker secretions which are more difficult for the patient to expectorate.  Pneumonia patients need hydration.  Often the infiltrates are more apparent after rehydraton. The chest film in Mycoplasma infection is highly variable but classically is a bilateral interstitial  pattern, but it may also be unilateral and is due to a hyperimmune response by the patients lymphocytes.  The unilateral image I will show you is often called a hilarious flair for the increased interstitial water radiating from one hilum on one side of the chest.  This infection has been termed “walking pneumonia” because patients may be entirely functional but have a marked cough with wheezing.  This is a self-limited infection the immune system will resolve but it gets worse before it gets better when left untreated and will last up to 6 weeks.  First line:  a macrolide such as a azithromycin plus a ß-agonist; second line includes gentamicin, erythromycin

HOW DO YOU DISTINGUISH BETWEEN A PORTABLE CXR AND ONE THAT IS A PA VIEW?

FREE AIR LEFT HEMIDIAPHRAM means ruptured viscus or recent laparotomy

FREE AIR UNDER THE LEFT HEMIDIAPHRAGM IS A RAPID WAY TO GET A PATIENT TO THE OPERATING ROOM.  IT ALWAYS MEANS A RUPTURED VISCUS WITH ONE EXCEPTION…IF THE PATIENT HAD A LAPAROTOMY IN THE LAST 24-48 HOURS GAS MAY STILL BE SEEN AND THIS WOULD SIMULATE A RUPTURED VISCUS.  ON A BOARD EXAM AS A TEST ITEM IT IS A RUPTURED VISCUS SCENARIO.  BOARD EXAMS ARE LOOKING FOR THE WORST CASE SCENARIO, LIFE AND LIMB THREAT, IATROGENIC INJURY…I WILL DISCUSS ALL OF THIS IN GREAT DETAIL OVER TIME.  FREE AIR CAN BE SHOWN AS AN ABDOMINAL CT AND THIS SIMPLE CT IS THE LEVEL OF A TYPICAL PART I CERTIFICATION EXAM TI OR EVEN A RECERTIFICATION TEST ITEM.  SO LOOK AT FREE AIR ON A CT IMAGE AND YOU WILL SEE BLACK GAS IN THE MOST ANTERIOR ABDOMEN BECAUSE THE PATIENT IS SUPINE.  I WILL SHOW SEVERAL EXAMPLES.  I WILL ALWAYS POINT OUT CLASSIC TIs. REMEMBER THAT FREE AIR FROM INJURY AND A RUPTURED VISCUS IS A PATIENT WHO MUST ALWAYS GO TO THE OPERATING ROOM FOR SURGICAL EXPLORATION AND REPAIR.  THINK AND DO OMI…GIVE RESUCITATIVE FLUIDS…CALL THE SURGEON…BASIC LAB WILL NOT CHANGE THE FACT THAT THE PATIENT WILL NEED TO GO TO THE OPERATING ROOM.  THE MOST IMPORTANT LAB TEST IS A TYPE AND SCREEN OR TYPE AND CROSSMATCH FOR BLOOD WHEN INDICATED.

When free air is seen under the right hemidiaphragm there is one additional consideration.  There is an anatomic variant in which the right colon as it becomes the transverse colon is actually located between the diaphragm and the liver.  This requires no treatment and is known as Chiladiti’s syndrome.  i will provide you with an example but the key is to look for the haustal markings of the large bowel.  Also the patient will have a benign abdomen if this is found as just an incidental finding.

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Clear your mind and remind yourself that each view has key items of interest.  A chest film has key zones or regions all of which must be examined or a finding may be missed.  One of the most common is to miss free air.  Here is a image of a lot of air-possibly tens of miles of it plus the clouds   Is it a photograph or a painting?  How can you decide?  Yes this is a little test.  Looking at different areas of the image may give you a different impression of the answer.  So I am reminding you to look at the spine, mediastinum(looking for pneumomediastinum*)  heart boarder, hear shape, and hear size.  Look at the lung fields with attention to visibility of intrathoracic air or fluid, i.e., PTX and/or fluid, pay attention to both hila for mass effect (downward displacement of the left hilum is a sign of aortic aneurysm)dd, the ribs for simple fracture (three or more adjacent rib fractures is enough to cause a flail chest (treatment is intubation).  Finally look at all of the soft tissues and for any lines (like a central line for proper position in the SVC; the proper position for an ET tube is 2-2.5 cm proximal to the carina, for a temporary transvenous pacer the tip must be to the left of the spine and should be in the RV.)  If the AV node is still functional one can actually pace a patient’s heart incorrectly with the tip of the wire in the RA.  It should be repositioned because loss of AV node conduction would then result in complete heart block and a pacer wire left in the RA would then stop working.  In the moment it is not so easy to decide what is wrong and seconds count in such a situation.  Finally look at both hemidiaphrams…the right is always slightly higher than the left.  Abnormal elevation of a hemidiaphragm in a patient with chest pain is classic for pulmonary embolism.  You will learn Hamptons hump and Westermark’s signs useful only if seen in pulmonary embolism.  [PE].  PE is much more specifically diagnosed with bedside ultrasound and I have some great videos to show you from actual cases.  The site is very static now but you will soon see it become much more dynamic and interactive.  Whenever an NG tube is placed you can make a lot of diagnoses potentially.  Always place one in all patients with a burn that is 20% of TBSA (and it must be placed within minutes because there is true risk of gastric rupture from lack of blood flow which has been diverted so gastric muscle tone decreases and from aerophagia (the swallowing of air) from the burn pain.  An NG tube that is displaced to the right of the T4 Vertebra by more than 2 cm is a useful sign of aortic aneurysm.  If a central line has been place and there is a large “hemothorax” on the same side the line may actually be pouring fluid into the pleural space (malpositioned).  Anytime you see gastric distention (e.g., with CPR) on a chest film, you should pass an NG tube to decompress the stomach; if the stomach is not then decompressed, check to make sure you don’t see the tube in the trachea or even the right mainstem bronchus.  The best clinical sign of proper NG tube placement is to be able to aspirate gastric contents and not by listening for gurgling while instilling air.  This can be positive and misleading when the NG tube tip is in the distal esophagus (hearing sounds that resemble gurgling)  This rapid list of pearls are all Tis from my Pearls of Wisdom electronic version ed. 7 soon to be available on a USB drive and will be available soon!

So what did you decide?  Painting or photograph.  Nature can sometimes produce dramatic changes in color in cloud formations from reflected or penetrating light……  but that yellow at the top is definitely my imagination and is not so common in real life.  When I see it I always take a photo!  This image is, however, imagination and on the iPad and it is actually a fingerprinting for the most part.  I though some of you might think well maybe it is grainy or slightly out of focus photo.  Clouds have a shaper side usually on the side of the light source.  The darker side appears softer and blended.  There are all sorts of interfaces in shading, tonal values, and intensity of color in clouds.  Understanding them will also help you understand what you see on a radiograph and even a CT image!

Neg bone window with STS left parietal soft tissue

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BACKGROUND CREATD FOR AN ULTRASOUND PRSENTATAION USING IPAD PRO

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