Crozer Flashcards
What is the treatment for anaphylaxis?
Airway – bronchospasm
o O2 40-100%
o Epinephrine 0.3-0.5 mL 1:1000 soln SC or IM q15min
o Albuterol 0.5 mL 0.5% in 2.5 mL NS nebulized q15min
o Benadryl 50 mg PO q4-6h
o Methylprednisolone 2-60 mg PO daily
Cardiovascular – hypotension
o IV fluids 1 L q20-30min prn
o Maintain systolic pressure >80-100 mm Hg
o Epinephrine 1 mg 1:1000 in 500 mL D5W IV at rate of 0.25-2.5 mL/min
o Norepinephrine 4mg in 1 L D5W IV at 0.5-3 mL/min
o Benadryl 50 mg PO q4-6h
Cutaneous reactions
o Epinephrine 1:1000 0.3-0.5 mL SC or IM q15min
o Benadryl 50 mg PO q4-6h
Document offending agent and educate patient on future avoidance
What is the difference between anaphylaxis and anaphylactoid reaction?
Clinically, they present the same, but anaphylactoid reaction is not mediated by the IgE antibody
and does not necessarily require previous exposure to the inciting substance
What are some absolute indications for a fasciotomy for compartment syndrome?
Tissue pressure above 30 mm Hg (normal 4 ± 4 mm Hg)
Sensory and motor loss
Pain out of proportion
How do you do a leg fasciotomy?
To do a leg fasciotomy, make one incision medial to the tibia and one lateral.
From the medial incision, open the superficial and deep posterior compartments. From the
lateral incision, open the anterior and lateral compartments
What are some techniques for measuring compartment pressure?
Wick catheter, slit catheter, Synthes catheter, needle technique, continuous infusion technique.
But as stated before, this should be a clinical diagnosis
what and Why tibialis anterior tendon transfer
Note: The STATT is slightly preferred due to fewer complications.
Indications: To decrease forefoot supinatory twist
To increase true ankle DF
Procedure:
1. TA is detached from its insertion
2. Reroute and insert it into lateral cuneiform or 3rd metatarsal (or inserted into peroneus
tertius if present)
What is Tachdjian-Grice
Note: Grice procedure = STJ arthrodesis
Indications: Congenital convex pes planovalgus (vertical talus!) + Ages 4-6 years old
Procedure:
1. First stage: TAL with posterior ankle and STJ capsular release
2. Second stage: (3 weeks later) STJ extraarticular arthrodesis
What is Stoffel
Indication: Correction of spastic muscular forms o
STATT
Note: Same as TATT but only half the tendon is used. See Special Surgery Section for details.
Indications: To increase true ankle DF and decrease long extensor swing phase
To decrease adductovarus forefoot
Procedure:
1. Detach half of TA from its insertion
2. Reroute and insert it into peroneus tertius (or cuboid, if peroneus tertius isn’t present)
Silver and Simon
Indication: Spastic equinus
Procedure:
1. Proximal release of gastroc without reinsertion of heads
2. Neurectomy of tibial branches to medial head of gastroc
OATS (Osteoarticular Transfer System)
Indication: Posterior medial talar dome osteochondral lesion
Procedure:
1. Take a plug of bone with articular cartilage from the knee
2. Through a trans-tibial approach, insert it into the talus (matching the contours of cartilage
on graft to dome of talus)
Murphy prodecure
Indication: Spastic equinus
Procedure: Anterior transfer of TA into calcaneus
Modification – route under FHL
Jones Procedure
Indications: Cock-up hallux Weak TA (procedure enhances DF) Procedure: 1. EHL is detached and inserted into 1st metatarsal head via a med → lat drill hole 2. IPJ fusion 3. Stump of EHL is attached to EHB
Hoffman-Clayton
Indications: MPJ subluxation secondary to rheumatoid arthritis and fat pad atrophy
Procedure: Resection of metatarsal heads 2-5 and bases of proximal phalanxes
Hoffman
Note: Often done with Keller arthroplasty
Indications: MPJ subluxation secondary to rheumatoid arthritis and fat pad atrophy
Procedure: Resection of metatarsal heads 2-5
