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DSE Test 1 > Injections and Casting > Flashcards

Injections and Casting Flashcards

1
Q

What is the number one reason to aspirate a joint?

A

Rule out infection

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2
Q

Besides ruling out an infection, what are other indications for aspirating a joint?

A
  • Symptomatic drainage of large effusion (may return!)

- To analyze synovial fluid to rule out causes of arthritis (i.e. gout)

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3
Q

What are some contraindications for joint aspiration?

A

Overlying cellulitis

-Also take caution with hemophilia, thrombocytopenia

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4
Q

What diagnostic should we do before we aspirate a joint?

A

X-ray:

  • Look for OA/RA
  • Rule out osteomyelitis
  • Rule out fracture
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5
Q

Should practitioners use CT/MRI before aspirating?

A

Can be helpful but we should not delay if we suspect sepsis

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6
Q

What joints can be aspirated in the clinic with minimal difficulty?

A

Elbow

Knee

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7
Q

Aspiration of what joints entails moderate difficulty?

A

Shoulder
Wrist
Ankle

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8
Q

What joints cannot be aspirated in clinic/ED setting (need radiographic help)?

A

Hip

Other special cases

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9
Q

What size needle is used in joint aspiration?

A

18 gauge

-No smaller than 22

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10
Q

What labs do we need after aspiration of a joint we suspect is infected?

A
  • Gram stain-STAT
  • Cell count-STAT
  • C&S-if indicated
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11
Q

What is a normal hematocrit value?

A

40-54%

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12
Q

What is a normal hemoglobin value?

A

12-18 g/dL

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13
Q

When analyzing blood, what does a moderate ESR elevation indicate?

A

Infection
Osteomyelitis
Other systemic illness

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14
Q

Aspiration of a joint with non-inflammatory arthritis will show what?

A
  • Clear, yellow, viscous fluid
  • 200-2,000 WBCs
  • <25% PMNs
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15
Q

Aspiration of a joint with inflammatory arthritis will show what?

A
  • Cloudy, yellow fluid
  • 2,000-100,000 WBCs
  • 25-50% PMNs
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16
Q

What locations should be avoided when giving soft tissue injections?

A

Major tendons:

  • Distal bicep
  • Patellar tendon
  • High risk of rupture!
17
Q

What is Euflexxa used for?

A
  • Knee joint pain with OA

- 3 shot series

18
Q

What are three viscosupplements used in OA?

A
  • Hyalgan (3 or 5 shots)
  • Supartz (3 shots)
  • Euflexxa (3 shots)
19
Q

What are three important goals in splinting/casting a fracture?

A
  1. Immobilize joints above and below fracture
  2. Make sure distal nervous, vascular, and somatic nerves intact before and after-DOCUMENT
  3. Make sure there are no open wounds, punctures, or deep abrasions
20
Q

What is a short arm splint used for?

A
  • Post-op distal radius ORIF
  • 2nd, 3rd, sometimes 4th MC fracture
  • Some ulnar styloid fractures
21
Q

What kind of splint is used for a trimalleolor fracture?

A

Combination of posterior leg splint and sugar tong leg splint

22
Q

Why should we use caution when immobilizing the knee joint?

A
  • Can lead to significant stiffness
  • Poorly tolerated
  • Good for patellar fractures and post-op knee surgery
  • Can increase risk of OA with decreased ROM
23
Q

What are short arm casts used for?

A
  • Carpal and Metacarpal fractures
  • Ulnar fractures
  • Not 1st MC or scaphoid fracture
  • Distal radius: use caution
24
Q

What are Muenster casts used for?

A
  • Control of pronation and supination

- Distal radius: use caution

25
Q

What is a long arm cast used for?

A
  • Distal radius
  • BBFA
  • Elbow
  • Some carpal fractures
26
Q

What is a long leg cast used for?

A
  • Distal tibia/fibula
  • Patella: caution
  • Severe collateral ligament (cylinder style)
27
Q

Why are long leg casts often set at 30 degrees?

A

Stops pt. from walking on it

28
Q

Treatment for a supracondylar fracture above elbow?

A
  • Posterior splint
  • NSAIDs
  • See ortho
29
Q

Treatment for a scaphoid fracture in 17 y.o. softball player?

A
  • Long arm spica

- Eventually CT/MRI for assessing risk of AVN

DSE Test 1 (2 decks)

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