Injections and Casting Flashcards
What is the number one reason to aspirate a joint?
Rule out infection
Besides ruling out an infection, what are other indications for aspirating a joint?
- Symptomatic drainage of large effusion (may return!)
- To analyze synovial fluid to rule out causes of arthritis (i.e. gout)
What are some contraindications for joint aspiration?
Overlying cellulitis
-Also take caution with hemophilia, thrombocytopenia
What diagnostic should we do before we aspirate a joint?
X-ray:
- Look for OA/RA
- Rule out osteomyelitis
- Rule out fracture
Should practitioners use CT/MRI before aspirating?
Can be helpful but we should not delay if we suspect sepsis
What joints can be aspirated in the clinic with minimal difficulty?
Elbow
Knee
Aspiration of what joints entails moderate difficulty?
Shoulder
Wrist
Ankle
What joints cannot be aspirated in clinic/ED setting (need radiographic help)?
Hip
Other special cases
What size needle is used in joint aspiration?
18 gauge
-No smaller than 22
What labs do we need after aspiration of a joint we suspect is infected?
- Gram stain-STAT
- Cell count-STAT
- C&S-if indicated
What is a normal hematocrit value?
40-54%
What is a normal hemoglobin value?
12-18 g/dL
When analyzing blood, what does a moderate ESR elevation indicate?
Infection
Osteomyelitis
Other systemic illness
Aspiration of a joint with non-inflammatory arthritis will show what?
- Clear, yellow, viscous fluid
- 200-2,000 WBCs
- <25% PMNs
Aspiration of a joint with inflammatory arthritis will show what?
- Cloudy, yellow fluid
- 2,000-100,000 WBCs
- 25-50% PMNs
What locations should be avoided when giving soft tissue injections?
Major tendons:
- Distal bicep
- Patellar tendon
- High risk of rupture!
What is Euflexxa used for?
- Knee joint pain with OA
- 3 shot series
What are three viscosupplements used in OA?
- Hyalgan (3 or 5 shots)
- Supartz (3 shots)
- Euflexxa (3 shots)
What are three important goals in splinting/casting a fracture?
- Immobilize joints above and below fracture
- Make sure distal nervous, vascular, and somatic nerves intact before and after-DOCUMENT
- Make sure there are no open wounds, punctures, or deep abrasions
What is a short arm splint used for?
- Post-op distal radius ORIF
- 2nd, 3rd, sometimes 4th MC fracture
- Some ulnar styloid fractures
What kind of splint is used for a trimalleolor fracture?
Combination of posterior leg splint and sugar tong leg splint
Why should we use caution when immobilizing the knee joint?
- Can lead to significant stiffness
- Poorly tolerated
- Good for patellar fractures and post-op knee surgery
- Can increase risk of OA with decreased ROM
What are short arm casts used for?
- Carpal and Metacarpal fractures
- Ulnar fractures
- Not 1st MC or scaphoid fracture
- Distal radius: use caution
What are Muenster casts used for?
- Control of pronation and supination
- Distal radius: use caution
What is a long arm cast used for?
- Distal radius
- BBFA
- Elbow
- Some carpal fractures
What is a long leg cast used for?
- Distal tibia/fibula
- Patella: caution
- Severe collateral ligament (cylinder style)
Why are long leg casts often set at 30 degrees?
Stops pt. from walking on it
Treatment for a supracondylar fracture above elbow?
- Posterior splint
- NSAIDs
- See ortho
Treatment for a scaphoid fracture in 17 y.o. softball player?
- Long arm spica
- Eventually CT/MRI for assessing risk of AVN
