LOBS Flashcards
what is an ‘error’?
A failure of planned actions to achieve the intended outcome
A deviation between what was actually done and what should have been done.
what is a slip error?
When there is a distraction during a routine task for example getting distracted and mis calculating a dose
what is a lapse error?
When there is unintended deviation from a routine procedure or standard approach
what type of errors are unlikely to be repeated?
Slip
lapse
what is a mistake?
failure in judgement due to a lack of knowledge
applying an incorrect rule to a problem
what is a violation?
A deliberate attempt not to follow accepted approaches
what is an active error>
errors occurring close to the patient
what is a latent error?
A system error upstream of the patient
what is the swiss cheese model of causation?
there are various layers of defences, barriers and safeguards but there are holes due to latent conditions so errors slip through
what are yellow flags of back pain?
- inappropriate attitudes and beliefs about back pain
- inappropriate pain behaviour
- work related problems or compensation
- emotional issues
what are typical symptoms of mechanical back pain?
- the symptoms vary with posture and activity
- typically between 20-55
- pain distribution often doesn’t go below the knees
what are the typical clinical features of inflammatory back pain?
- age between 20-40 years
- a slow onset of symptoms
- chronic pain
- morning stiffness that improves with activity
- usually affects the axial skeleton
- extra- skeletal features like uveitis may be present
what are some examples of causes of inflammatory back pain?
ankylosing spondylitis
reiters syndrome
reactive arthritis
what are clinical features of back pain due to nerve roots?
- usually occur at the lumbar levels
- sciatica can spread down the feet and cause weak calves
- unilateral leg pain
- radiates below the knees
- numbess and parathesia
- motor, sensory and reflex changes
what way does a vertebral disk herniate?
posterior-lateral
what are signs of a prolapsed vertebral disk?
lower back pain
muscle spasm
often unilateral
radiates to the buttocks
what are the changes in an L2 nerve impingement?
sensory changes in the front of the thigh
no reflex changes
weak hip flexion and adduction
what nerve root is affect in an L1/L2 prolapse?
the lower of the two adjacent vertebrae
L2
what are the changes in an L3 nerve impingement?
sensory changes of the inner thigh and knee
loss of knee reflex
weak knee extension
what are the changes in an L4 nerve impingement?
sensory loss of inner calf
loss of knee reflex
weak knee extension
what are the changes in an L5 nerve impingement?
sensory changes of outer calf and middle/upper foot
no reflex change
weak inversion and dorsiflexion
what are the changes in an S1 nerve impingement?
Sensory changes in the posterior calf and lateral foot
loss of ankle reflex
weak plantar flexion
what is spondylolisthesis?
A vertebrae slips anteriorly
what are causes of proximal myopathy?
PEACH POD P- polymyositis E- endocrine A- alcohol C- carcinoma H- HIV P-eriodic hypokalaemia paralysis O- osteomalacia D- drugs S- sarcoidosis
what are endocrine causes of proximal myopathy?
Thyroid changes, raised ACTH, raised glucocorticoids, adrenal insufficiency, raised PTH
what carcinomas tend to cause proximal myopathy?
small cell, breast, prostate
what drugs are known to cause proximal myopathy?
statins
steroids
what are red flags of back pain?
T- trauma U- unexplained weight loss N- neurological sighs A- age >50/<20 F- fever I- IVDU S- steroids H- history of prostate, renal, breast cancer
what are signs of cauda equine?
lower limb weakness sacral numbness urine retention erectile dysfunction decreased reflexes
what are the actions of PTH?
- causes calcium release from bone
- acts on the kidney to increase calcium reabsorption
- increases osteoclast activity
- increases intestinal calcium absorption
what are the actions of calcitonin?
decreases calcium in the blood
inhibits PTH
