MEMORIZE MISC Flashcards
CanMED scenario principles
- understand that this is a very difficult situation for the patient and family.
- I will arrange for private area to sit and
discuss the matter more fully. - Following the SPIKES framework, using non-judgemental, simple intelligible
speech - I will empathetically respond to the patient’s concerns and answer any questions they have
- while I was not at the original sx, cannot speak for my colleagues
- my goal is to provide the best care moving forward at this point which involves X
spikes : setting, perception, invitation, knowledge, empathy, summarize or strategize
Recommendations
for perioperative
Mx rheumatoid
drugs
General algorithm
Continue (MTX and hydroxychloroquine)
1 day (leflunomide)
1 week (SANE -sulfasalazine, azathioprine, NSAID, etanercept)
1 month (the rest)
2 months (rituximab)
Post op NSAIDS re-start POD1-2 and rest are 2 weeks
Specifics from JAAOS
1 NSAIDS – discontinue within 1 week before surgery. Aspirin at least 72 hr
2 MTX -continue
3 Sulfasalazine – 1 week preop
4 Azathioprine – 1 week preop
5 Leflunomide – 1-2 days preop, with cholestyramine to remove active metabolite, start 1-2 week postop
6 Hydroxychloroquine – continue
7 Etanercept – 1 week preop and restart 1-2 week postop
8 Infliximab – hold 1 month preop, reinstated 1-2 weeks postop
9 Golimumab – hold 1month preop restart 1-2 week post op
10 Toclizumab – hold 1 month preop
11 Abatacept – hold 1 month preop
12 Adalimumab – hold 1 month preop
13 Certolizumab – hold for 1 month preop
14 Rituximab – hold for 2 months preop
Checklist preop,
intraop, postop
Surgical safety checklist prior to induction
1 Confirmed patient, site, procedure and consent obtained
2 Site is marked
3 Anesthetic concerns
4 Allergies
5 Anticipated blood loss greater than 500cc
Checklist/Timout prior to skin incision
1 Confirm all team members know each other
2 Confirm patient name, procedure, side
3 Antibiotics
4 Anticipated critical events
5 Anesthetic concerns
6 Nursing concerns
7 Imaging available
Prior to leaving OR
1 Name of procedure (nursing)
2 Confirm counts are correct (nursing)
3 Specimens labelled (nursing)
4 Surgeon/anesthetic concerns in post operative management
Motor innervation
UE
1 PIN = Supinator + all extensors except ECRL
2 Radial = Triceps/BR/ECRL/anconeus lateral half brachialis
3 Median = All forearm flexors except ulnar half of FDP, FCU, LOAF in hand
PT, FCR, PL, FDS) (hand 1st and 2nd lumbricals, opponens pollicis, APB, FPB
4 AIN = FDP 2 & 3, FPL, PQ
5 Ulnar = ulnar half FDP, FCU and all intrinsics except LOAF
FDU, FDP 4 & 5
Thenar group (adductor pollicis, deep head FPB)
Dorsal and palmar interossei, lumbricals 3 & 4
Hypothenar group (abductor digiti minimi, opponens ditigi minimi, flexor digiti minimi
6 Musculocutaneous = coracobrachialis, biceps, medial ½ brachialis
7 Axillary = Deltoid & teres minor
Indications for
bisphosphonate
1 Post-menopausal women and men >50 years with T score < -2.5 other causes excluded
2 Post-menopausal woman and men > 50 with T score between -1 and -2.5 with secondary cause
3 Treatment of glucocorticoid-induced osteoporosis
4 Hypercalcemia of malignancy
5 Paget’s disease of the bone
6 Malignancies with metastasis to the bone
7 Osteogenesis imperfecta in children and adults
T score compares bone density to an average healthy 30 year old.
Normal T score = -1 to + 4
Osteopenia = -1 to -2.5
Osteoporosis < -2.5
Z score compares bone density to others of same age and gender.
nerve damage classification
Neurapraxia = Axon intact, myelin damage, endoneurium intact (compression, nerve dysfunction because myelin is disrupted, but all components intact, will re-gain function)
Axonotemesis = Axon and myelin damage, anything except the epineurium may be disrupted
Neurotemesis = Axon and myelin and everything up to and including the epineurium is disrupted
Medical errors schpeel
I will disclose the error to the patient including the impact of that error on their medical treatment and disclose our
plan to prevent future errors from occurring. I will apologize to the patient and using non-judgemental speech
listen to their concerns and answer any questions they may have.
I will provide appropriate practical and emotional support and document the disclosure.
steps for management of IPV
What to say for IPV
1 I will validate their feelings (not her fault), unfortunately this is very common
a Ensure this is conversation is confidential
2 Thoroughly document the complaints
a Clinical photographs where applicable
3 Find out if other’s are at risk
a Children
b Elderly
4 Offer support through hospital
a Social services
b Shelter
c Exit plan
d Toll free numbers
e Counselling
f Support groups
g Legal services
4 Work together to document a plan with regards to the orthopedic injury and the social issues, and obtain a
follow-up.
How do you screen for IPV?
“Because violence is so common in many women’s lives and because there is help available for women
being abused, I now ask every patient about domestic violence.”
What questions would you ask a patient with IPV?
1 Have you been physically or emotionally hurt by anyone in the last year? If so by whom?
2 Do you feel safe in your current relationship?
3 Is anyone making you feel unsafe now?
4 Does she have children at risk or is she or others in immediate risk?
I will include a chaperone witness and take a thorough history in private inquiring about the nature of the
present visit, history of IPV, RF for IPV (including complete social history and details about current
relationship) and inquire whether there are dependents or children at risk. I will investigate what barrier’s
this patient may have to reporting the IPV.
I will perform a thorough physical examination with written and photographic documentation of any
bruises, lacerations or deformities as a result of IPV.
Using nonjudgmental empathetic speech, I will listen to the patient’s concerns. I will encourage the patient
to report violence to police and direct them toward available resources which include shelters, support
groups, social workers and counselling services.
In the event they are not ready to report, I would encourage them to have a safe location (e.g. residence of
friends or family) they can utilize in an emergency situation and a bag packed which has emergency supplies
including identification, money and change of clothes.
Canmeds
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