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Discriminative sensations, casting, dislocation Flashcards

1
Q

How should you help the patient feel like they have privacy at the appt?

A
  • close nearby doors and draw curtains
  • wash hands each time you see a patient
  • drap patient with gown or sheet
  • describe what you are going to do to the patient before doing it
  • keep patient informed throughout exam
  • make instructions courteous and clear
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2
Q

When doing the discriminative sensation exam, should patient eyes be open or closed?

A

closed

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3
Q

Stereogenesis

A
  • Ability to ID an object by feeling it
  • Place a familiar object in hand and have patient tell you what it is
  • Normally a patient will tell you what it is in 5sec
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4
Q

How to add a sensitivity component to stereogenesis

A

have patient tell you if coin is head or tails

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5
Q

Astereogenesis

A

inability to recognize objects in hand

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6
Q

Graphesthesia

A
  • number identification
  • Used for patients with motor impairment, arthritis or conditions preventing them from manipulating an object in hand
  • With blunt end of pen, draw a number on patient palm and a normal person can ID it
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7
Q

Two point discrimination

A
  • Using two ends of open paper clip touch a finger pad in two places simultaneously
  • Alternate with one point
  • Determine the minimal distant at which a patient can discriminate 1 from 2
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8
Q

Normal response in two point discrimination

A

<5mm on finger pads

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9
Q

What increases the distance between two points in two point discrimination

A

lesion of sensory cortex

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10
Q

Point localization

A
  • Briefly touch a point on the patients skin
  • Ask patient to open eyes and point to area touched
  • Normally it can be done accurately
  • Useful on trunk and legs
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11
Q

Extinction

A
  • Simultaneously stimulate corresponding areas on both sides of the body
  • Ask where the patient feels your touch
  • Normally both are felt
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12
Q

If a patient has a lesion on the left side of sensory cortex, where will the stimulus on leg be extinguished

A

right side

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13
Q

A lesion in what area will effect discriminative sensations

A

sensory cortex

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14
Q

What is a shoulder dislocation

A

head of humerus is out of socket (glenoid cavity)

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15
Q

What is a subluxation

A

temporary and partial dislocation

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16
Q

Patient with shoulder dislocation will have?

A

poor ROM and lots of pain

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17
Q

arm is slightly abducted and externally rotated; humeral head may be felt anteriorly and the void seen posteriorly (sulcus signs)

A

Anterior dislocation

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18
Q

If anterior dislocation, is there injury to axillary nerve

A

NO

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19
Q

patient arm internal rotation and adducted; prominent humeral head seen and palpated posteriorly; patient guards the extremity

A

posterior dislocation

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20
Q

Treat shoulder dislocation

A
  • prompt reduction or glenohumeral joint
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21
Q

Increased risk of a patellar dislocation

A

Patellofemoral malalignment, abnormal patellar configuration and previous history of instability

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22
Q

Acute pain after direct contact or sudden change in direction, fell the knee giving way due to quad pain, rapid swelling, intense knee pain and difficulty with knee flexion, joint knee effusion

A

patellar dislocation

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23
Q

If there is significant tenderness medially near the medial retinaculum what do we think

A

tear

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24
Q

Apprehension sign

A

Knee placed at 30 degrees flexion and leteral pressure is applied. Medial instability results in apprehension by patients

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25
Q

Treat patellar dislocation

A

If fracture noted with dislocation obtain orthopedic consultation

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26
Q

Where do we immobilize a joint

A

above and below the injury

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27
Q

How do we wrap the ace

A

distal to proximal to prevent trapping of blood distal to injury

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28
Q

What must we do before an after splinting

A

distal circulation, motor function and sensation

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29
Q

Pain with a splint or cast is what?

A

compartment syndrome

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30
Q

Do preformed splints provide same level of immobilization as custom

A

NO

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31
Q

What type of water do we use when splinting and casting

A

room-temperature

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32
Q

What happens when plaster put in water

A

gypsum recrystallizes and harden in an exothermic reaction

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33
Q

Complications of splinting

A

too loose: sores and abrasions

too tight: neuromuscular compromise/injury, contact dermatitis, pressure sores

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34
Q

Stockinette sizing

A 
1in= finger and thumb
2in= hands and young kinds
3in= upper extremity
4in= legs
35
Q

When using Webril, how much do we overlap each layer

A

50%

36
Q

Why do we use Webril

A

protect the skin from chaffing or blisters from hard splint material

37
Q

What do we use for shoulder and humeral injuries

A

sling and swather

38
Q

Sling without swather for

A

clavicle fractures

39
Q

What does the sling and swathe do

A

Sling supports weight of arm and swather holds arm against chest to minimize shoulder motion

40
Q

When do we give a cast

A

5-7 days after injury and swelling has resolved

41
Q

TOC for nonoperative fractures

A

castign

42
Q

How long do we keep a cast on? When do we change it?

A

4-6 weeks; 3 weeks

43
Q

How much padding for casting

A

2 layers UE, 3-4 layers LE

44
Q

Goal of molding cast

A

maintain alignment of fracture

45
Q

What shape is best to maintain fracture alignment

A

elliptical

46
Q

3 point molding

A
  • 1st point over apex of fracture with force directed opposite direction of fracture to displace
  • two remaining points lie on opposite side of bone at either side of apex
47
Q

DTR 4+

A

Very brisk, hyperactive with clonus

48
Q

DTR 4+ common in

A

CNS lesions along the descending corticospinal tract

49
Q

DTR 3+

A

Brisker than average; possibly but not necessarily indicative of disease

50
Q

DTR 2+

A

Normal

51
Q

DTR 1+

A

Somewhat diminished; low normal

52
Q

DTR 0

A

no response

53
Q

DTR 0 seen in

A

disease of spinal nerve roots, spinal nerves, plexuses or peripheral nerves

54
Q

Assisted ventilation can

A

decrease ICP or correct hypercarbia and acidosis

55
Q

Oxygenation needed in people with

A

severe lung disease of injury who are unable to maintain acceptable PaO2

56
Q

Why do people need airway managed

A
  • Overcoming or preventing airway obstruction
  • Prevention of aspiration
  • Administration of intratracheal drugs
57
Q

Does a CXR confirm placement into trachea

A

NO

58
Q

Key airway landmarks

A
  • Thyroid lamina
  • Arch of cricoid cartilage
  • Median cricothyroid ligament
59
Q

Miller versus McIntosh

A

Straight laryngoscope bade is Miller and curved is McIntosh

60
Q

Who gets cuffed tube

A

adults and older kids

61
Q

Best method to confirm placement of ET

A

see tube pass through cords

62
Q

What is rapid sequence intubation

A

method of safely paralyzing and intubating a patient with a full stomach to prevent aspiration

63
Q

When to use NG tube

A

gag is present

64
Q

When to use oropharyngeal tube

A

gag absent

65
Q

When house bag-valve apparatus

A

NG tube places

66
Q

What hand laryngoscope held

A

Left

67
Q

MC intubation

A

orotracheal

68
Q

MC cause spinal trauma

A

MVC and falls

69
Q

Most important thing to establish in patient with spinal injury

A

mental status normal

70
Q

RA can lead to

A

subluxation problems C1/C2

71
Q

X-rays obtained in potential spinal injury

A

cross table lateral and c-spine

72
Q

Missed injuries in cross table lateral

A

injury at C1/C2

73
Q

When assess c-spine films what are we looking at in soft tissue

A

Preverebral swelling, especially at C2-C3 (more than 5mm), and check the predental space, which should be <3mm in adults and <5mm in kids

74
Q

CT is used to ID

A

vertebral fractures and handling

75
Q

MRI used for

A
  • Evaluation of injury of spinal cord itself or rupture of the intervertebral disc
  • Demonstrate areas of contusion and edemain the cord, as well as areas of compression
76
Q

Important things to do with C-spine injuries

A

proper immobilization and caution handling

77
Q

In a C-spine injury, you may not be able to maintain what? How to treat?

A
  • tidal volume because intercostal muscles are nonfunctional

- monitor respiratoyr status

78
Q

SCIWORA

A
  • spinal cord injuries without radiograph abnormalities

- Children more susceptible because greater elasticity of cervical structures

79
Q

What do we assume if pain perception is altered by alcohol, drugs, head injury, shock or other causes?

A

injury is present

80
Q

AMUST

A

A=Altered mental state. Check for drugs or alcohol.
M=Mechanism. Does the potential for injury exist?
U=Underlying conditions. Are high-risk factors( e.g.,RA) for fxs. present?
S=Symptoms. Is pain or paresthesia part of the picture?
T=Timing. When did the symptoms begin in relation to the event

81
Q

Key questions to guide framing of nervous system exam

A

1) Is the mental status intact?
2) Are your findings symmetric?
3) Where is the lesion?

82
Q

Uber Motor Lesion

A 
Hypertonia
Hyperreflexia
No fasciculation's
No atrophy
Positive Babinski
83
Q

Lower Motor Lesion

A 
Hypotonia
Hyporeflexia
Fasiculations
Atrophy
Normal plantar reflex
84
Q

Most important part of shoulder reduction

A

relaxation of the shoulder musculature

! (11 decks)

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