Hip Case Mx Flashcards
Hx
N root pain dermatomal comm L4,5,S1, in leg below knee.
Classic hip- groin, buttock, to knee.
Time 0 event
Reach feet, sit to stand
Pmh- when diag and how, monitoring since, curr readings, symp freq, stable meds, complics.
Sev- rest pain, post rest stiffn, walk dist and mobil, noc pain, walk aids.
Exam
Hip, knee, spine and periph neurology
Look- stand, gait, trendel
Feel- landmarks with flat hand, GT, fem pulse.
Move while look face active foll by passive- assive rot in ext to assess pain, SLR, flex, IR, ER, abduc and adduc with hand on opp ASIS.
Thomas test- active flex one hip and hold. Hand under L spine, stop flex when spine to hand.
Leg length- true ASIS to MM, appar from 2pts, galeazi.
Pulses
Neurology
OA signs
-Imp three- Fixed flexion- lean forw when stand, walk on ball Loss abduc- aduction contracture, see on standing, looks valgus Ext rot- foot turned out -others- Musc wasting Pain on palp and movem, esp int rot Crepitus Length, asymm Gait abn- antalg, SL, trend Reduc ROM
Mobil aid
Lean tow affected to reduc musc effort
So hold stick in opp hand
PAC
Hx Exam Drug chart, VTE risk ass Bloods- FBC, grp save, Hba1c, UE, gluc (if high no elective), clotting if hx Maybe ECG, CXR Consent Allergy Obs, BMI etc Swab MRSA XR within 6 mnth Urine dip
surg risks
Infec Bleed DVT, PE N damage eg sciatic MI, CVA Death Failure Frac Wear out Disloc
peri op meds
Co amox IV 1.2g on induc then 2 doses 8 hourly
Deltaparin evening til mobile or disch
Codeine. paracetamol 1g QDS. Somet oramorph. Occas NSAID. Dihydrocodeine 30mg QDS.
Cyclizine 50mg oral/IM/SC. metoclopramide 10mg.
Fybogel bulking, then stims eg senna, then lactulose.
Clot mx- asp 150mg 6 wk. Early mob. Comp stocking. If prev clot- advise from haematol, extend stand TP, LMWH and warfarin 3 mnth if v high risk.
on day surg
NBM Stopped anticoag for at least 1 wk Consent and further Qs Mark Illness since last meeting Drug chart compl Bloods results there and checked
