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Houseman (break your leg) > Orthopedics > Flashcards

Orthopedics Flashcards

1
Q

Amputation

A 
Assessment
Resuscitation
Wound care
Preservation of amputated limbs
Re-implantation

Mx:

  • general principles of wound care
  • preservation of distal stump (gauze soaked with NS, into clean plastic bag, into bag of cold water with eyes, store in fridge)
  • inform MO
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2
Q

Compartment syndrome

A

Etiology:

  • crush inj
  • tibial #
  • vascular compromise (e.g. dislocation of knee)
  • compression within complete pop

Sign:

  • exaggerated pain on passive stretching of ms grp involved
  • paraesthesia
  • paralysis
  • pulseless
  • perishingly cold
  • pallor

Compartmenet pressure: <40mmHg within all compartment

Mx: 
NPO
IVF
Elevate limb
Inform MO
EOT x fasciotomy, debridement +- # fixation
Consent
Pre-op abx
U bedside fasciotomy if critical

ALL CONFIRMED COMPARTMENT REQUIRE U FASCIOTOMY!!!

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3
Q

Necrotizing fasciitis

A

RF:

  • Elderly
  • Cirrhosis
  • DM
  • Immunocompromised (steroid)
  • Marine organism inj/ contact

Organism: vibrio, GAS, others e.g. mixed organism

Dx:

  • +- septic
  • rapidly progressing cellulitis in hours (spread proximally in abn rapid manner)
  • clinical signs: bullae/ blister, patchy cyanosis, painful->painless/ numb, superficial venous thrombosis
  • aspirate SC plane with angiocath + send for U Gm smear
Mx:
NPO
IVF +- fluid resuscitation
Obs Q1H (BP/P, T, UO +- CVP +- Hstix)
U inorm MO
U consult microbiologist
IV antibiotics (PenicillinG + ciprofloxacillin)
Book EOT x debridement +- amputation
Consent major _0 minor
Routine pre-op workup
T&S bld products (FFP PLT)
Bld C/ST
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4
Q

Open fracture

A

Assessment
Resuscitation
Wound care
# stabilization

Mx
NPO (if plan OT under GA)
IVF
Gustulo classifiocation
Type of wound and extent of soft tissue inj
Degree of contamination
Associated bony tendon vascular neurological inj
Other concomitant inj
General condition
Wound swab x C/ST
Irrigate wound with 2L NS
Stabilize fracture temporariy with backslab
Eleavte injured limb
Abx (cloxacillin 500mg IV Q6H, gentamycin 80mg IV Q8H +- Flagyl 500mg IV Q8H)
Analgesics (dologesic tab 1 QID PO prn, doloxene 50-75mg Q6H IM prn)
Inform MO
Expect significant bld loss with #pelvis, shaft of femur, wound with active bleeding
- + T&S, close monitoring obs Q1H

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5
Q

Open wound

A

All open wound Tx <12H of inj, heavily contam/ bite wound Tx as potentially infected wound (NO immediate closure)

Assessment
Surgical toilet and debridement (contaminated -> tidy)
Reconstruction if indicated

Mx:
NPO (plan exploration under GA)
IVF
Assessment of wound type (crush, abrasion, laceration, penetration, deglove inj, burn)
Assessment of degree of contamination (clear wound, clean contaminated, heavily contaminated, infected)
Associated bony, tendon, nerve, vascular inj
Concomittant inj over other parts of body (e.g. HI)
General condition (ASA 12345)
Wound swab x C/ST
Irrigation of wound with 2L NS
Abx (ampicillin and cloxacillin 500mg QID PO/IV)
Analgesics (dologesic tab 1 QID PO prn, doloxene 5omg Q6H IM prn)
Inform MO if debridement/ repair indicated

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6
Q

Septic arthritis

A

Dx

  • Septic (high fever, tacycardia, septic looking, WCC)
  • Joint inflammation: effusion, inflammation (red, T, swelling), protective ms spasm with decrease ROM, severe pain on moving joint
  • Knee tap (pus, R/M show bacteria +- WCC >10^6/mm3, Gm smear, C/ST)

Mx:
NPO
Obs Q1H (BP/P UO with foley to BSB)
IVF +- fluid resuscitation
Diagnostic knee tap + send aspirate x U Gm smear C/ST R/M biochem
Routine preop workup (CBC LRFT PT/APTT CXR ECG)
Bld x C/ST
Abx (Zinacef 750mg IV Q8H after knee tap/ bld cst)
Inform MO
EOT + consent AFTER MO assessment

DM: watch out for DKA

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7
Q

Severe and multiple trauma

A

Triage (GCS, breathing, shock)
Priorities:
- life support e.g. CPR/ IVF
- control bleeding
- prevent spinal cord damage
- Dx evaluate other inj/ Cx
Basic Mx
- emergency: ABC
- fluid: 2-3 14-16G IV cannula
- O2
- T&S
- Analgesics
- UO monitoring (foley unless suspected rupture urethra (e.g. bld at meatus, severe fractured pelvis)
- Evaluation of other inj:
1. HI: GCS, neuroobs Q1H, inspect for CSF/ bld in ears/ nose, SXR (3views) +- CTB
2. Facial inj: r/o bleeding airway/ oro-pharyngeal edema (caustic bun), SMV OMV XR
3. Spinal inj: immobilize, signs of spinal cord inj (paralysis, diaphragmatic breathing, vasomotor tone loss, lax anal tone), cervical spine #/dislocation to be r/o if HI (XR C-spine AP and lateral)
4. Chest: hemothorax/ PTX lung contusion, flail chest,, CXR
5. Abdomen: ruptured viscera (hemoperitoneum, peritoneal signs), retroperitoneal h’age (pelvis), renal inj (hematuria/ loin pain), AXR
6. Pelvis #: stability, ruptured bladder/ urethra, XR pelvis (AP inlet outlet)
7. Limbs: Long bone #, nerve/ arterial dmg

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8
Q

E OT

A 
EOT under GA: 
NPO
IVF
Hstix Q4H if DM
CBC LRFT T&S
CXR ECG Bld x Astrup PT/APTT (>60yO)
\+- Bld products (FFP PLT)
Consent for major, consent for minor (<18yo >65yo dementia unconscious mentally unfit)
PPP for operation
Pre-op antibiotics +-
Book EOT, inform anes
EOT under LA:
DAT
Consent for major, consent for minor +-
PPP for operation
Pre-op antibiotics
Book EOT
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9
Q

Listed OT

A 
Listed OT under GA: 
NPO after midnight day before OT
IVF
Bld x CBC LRFT PT/APTT T&S Bld x astrup
\+- Bld products (FFP, PLT)
Consent for major/ consent for minor
PPP for operation
Pre-op antibiotics
Listed OT under LA: 
DAT
Admission forms
Consent for major/ consent for minor
PPP for operation
Pre-op antibiotics
If removal of implants, XR (AP + Lat) of region
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10
Q

Emergency to inform MO

A
  1. Open fracture/ dslcoation
  2. Open wound (debridement and repair
  3. Dislocation with unsuccessful closed rduction
  4. # / disclocation with> jeopardized circulation
    neurological deficit
  5. Compartment syndrome
  6. # NOF in young <60yo
  7. Unstable spinal fracture
  8. Traumatic limb amputation requiring re-implantation
  9. Spinal cord lesion with neurological deficit (acute spnal cord compression, acute cauda equina)
  10. Necrotizing fasciitis
  11. Septic arthritis
  12. Wet gangrene
  13. Abscess
  14. Pedicatric case
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11
Q

Prophylactic heparinization

A

Ix: caucasian, patient with DVT + # LL pelvis prolonged immobilization
Tx: heparin 5000U SC Q12H

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12
Q

IVF

A 
Ordinary patients: 2D1S Q8H or Q6H
DM patients: D5 + 5mmol K + 4U Actrapid Q8H or Q6H
Pediatrics: 1/2 1/2 rate acc to BW
 - first 10kg: 100ml/kg/D
 - second 10kg: 50ml/kg/D
 - then: 10ml/kg/D
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13
Q

Fracture

A
  1. Open vs Closed
  2. Simple vs Comminuted
  3. Transverse, wedge, oblique
  4. Site
    > intra-articular vs extra-articular
    > epiphysis, metaphysis, diaphysis
    > bone (radius, ulna, humerus, tibia) minuted)
    - neurovascular inj
    - concommitant inj
    Treatment
    - reduction
    - immobilization
    - rehabilitation always
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Houseman (break your leg) (23 decks)

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