Orthopedic Pain Management, Orthopedic Infections, Pediatric Orthopedics Flashcards
Tramadol
High potential for physical and psychological dependence
Acts on Mu receptors - inhibits NE and serotonin
Effective for neuropathic pain, improved functional outcome with fibromyalgia
Metabolized in liver
Use with caution in elderly and with renal insufficiency
Toradol and Indomethacin NSAID Class and Risks
Acetic Acid
Indomethacin increases risk of GI bleed, also may be associated with aplastic anemia
Toradol use >5 day increases risk gastropathy
Carisoprodol (Soma)
Indirect skeletal muscle relaxer
Meprobamate (metabolic product) has anxiolytic properties
CI: Porphyria - inherited porphobilinogen deaminase mutation with abdominal and urinary symptoms, peripheral neuropathy, systemic and CNS effects
Cyclobenzaprine (Flexeril)
Muscle relaxant - structurally similar to TCAs
Relieve local skeletal muscle spasms w/o interfering with muscle function
Lasts 12 hours
Anticholinergic effects
CI: Concurrent MAOI use, acute MI phase, arrhythmias, heart block
Diazepam (Valium)
Centrally acting skeletal muscle relaxant
Depresses muscle excitability via GABA inhibition
Only benzodiazepine approved for treatment of muscle spasms or disorders
Methocarbamol (Robaxin)
No direct action on contractile mechanism of striated muscle, motor end plate, or nerve fiber
Less sedating than other muscle relaxants
Osteomyelitis - Hematogenous
Vertebrae is MC site
Staph aureus is MC bug
Pain, constitutional sx that can be acute or long-standing
Osteomyelitis - Vertebral
Lumbar is MC
Staph aureus MC - Pseudomonas w/ IVDA and puncture wounds
Fever, localized pain for 3 weeks - 3 months
May result in meningitis or abscess with motor/sensory deficits
Osteomyelitis - Contiguous
Without generalized vascular insufficiency: Staph; direct bone trauma, infection spread, nosocomial, or prosthetic infection
- infection occurs 1 months after primary infection cause w/ pain and fever with drainage of area
With generalized vascular insufficiency: Charcot’s foot with multiple bugs; present w/ ulcers, multiple foot problems from peripheral neuropathy and small vessel disease; affects small bones of foot
Septic Arthritis in Adults
Knee is MC joint affected
Neisseria gonorrhea MC, staph emerging as MC non-gonorrhea
Warm, swollen painful joint - aspirate
Surgical emergency
Septic Arthritis in Children
Peaks at 3 yo
80% in hip - flexed, abducted, and externally rotated w/ severe pain to PROM and rotation
Fever, edema, erythema, effusion, pseudoparalysis
Staph aureus MC
Think group B strep and gram negative bacilli in neonate
Developmental Dysplasia of Hip - forms
Teratologic
Unstable hip
Dislocated hip
Subluxated hip
Acetabular dysplasia
Teratologic: fixed dislocation, occurs prenatally, associated w/ neuromuscular disorder
Unstable hip: Femoral head reduced - can fully dislocate or partially subluxate
Dislocated hip: femoral head doesn’t articulate; may not be reducible
Subluxated hip: femoral head contacts a portion of true acetabulum
Acetabular dysplasia: acetabulum shallow so femoral head subluxated or normal
