Blessington lecture Flashcards
what is the most common joint in the body to dislocate?
proximal interphalangeal joint
does a shoulder typically dislocate anteriorly or posteriorly?
anteriorly
what is the re-dislocation rate in young people and athletes?
90 percent
scapular rotational maneuver would be a good option for shoulder reduction in which population?
elderly patients and those without huge amounts of muscle mass
which reduction technique for shoulder dislocations requires the patient to hold a weight to slowly bring the shoulder back to place? what may you want to do for this technique?
stimson’s technique
sedate but not overly sedate (airway issue because they’re on their stomach)
which technique for shoulder reduction requires two people? who is it commonly employed for?
traction countertraction
common for muscular patients/dislocated for long periods
why may the external rotation technique for shoulder reduction be difficult?
requires a lot of cooperation from patient
what should you do immediately following shoulder reduction?
1) immobilize shoulder in sling
2) post reduction films
3) evaluate neurovascular function
what should you tell your patient to do in terms of recovery following shoulder dislocation?
avoid abduction and external rotation (hair brushing)
immobilize for 2-4 weeks, PT therapy is advised
what are the three phases of wound healing?
1) inflammatory phase (2-5 days)
2) proliferative phase (2 days-3 weeks)
3) remodeling phase (3 weeks-2 years)
scar tissue is only ___ percent as strong as original skin tissue
80 percent
order the following in terms of when they occur: epithelialization, granulation, contraction
1) granulation: fibroblasts lay bed of collagen
2) contraction: wound edges pull together to reduce defect
3) epithelialization
which type of wound closure allows for the best cosmetic results? which wounds are typically closed by this method?
primary intention
best on wounds that are ‘clean’ and uncomplicated
what is the type of wound closure that allows a wound to heal on its own through granulation and re-epithelialization? when is this appropriate?
secondary intension
for abscesses, fight bites, dirty wounds, or if a wound is >12 hours old
if you decide to leave a patient’s wound open for 1-3 days and then surgically close it, what is this called? why do we do it?
tertiary intension
- done to allow tissue edema to reduce (ortho injuries)
- wounds with likely chance of infection (abdominal incision post rupture appendix)
how can you remove grease from an injury?
bacitracin/polysporin ointment
what should you do if a patient presents with a “ragged” appearing injury with poorly-approximated wound edges?
trim with iris scissors and scalpel to minimize necrotic tissue and decrease likelihood of infection
how long should your patient leave the initial dressing on following surgical closure of a laceration?
24-48 hours, return to re-apply second dressing
with what types of lacerations do we want to refer out?
eyelids (plastics or opthalmology)
ear if full thickness (ENT)
what is the DOC for animal bites?
augmentin
what type of fracture are subungual hematomas often associated with?
distal phalanx tuft FX
how do we treat subungual hematomas?
trephination with cautery stick
before you cauterize someones subungual hematoma, what should you clean with?
not alcohol! it will light on fire
use betadine
what are the desired effects of conscious sedation?
relaxation, cooperation, protective airway reflexes, purposeful responses to verbal or tactile commands
