Recon_Scenario

Question 1

Recon_Scenario

Answer 1

1. History
   
   1. CC - Given
   2. Age/Sex/Race
   3. O nset
   4. P osition
   5. Q uality/Quantity
   6. R adiation
   7. S ymptoms associated
      
      1. Neurologic
      2. Mechanical
      3. Constitutional
      4. Local
   8. T iming
   9. AA
   10. PSHX, PMHX, Meds, Allergies
   11. Family Hx, Social Hx (EtOH, tobacco)
   12. ADLs
       
       1. THA Questions
          
          1. Rising from chair without, with support, unable
          2. Walking time without support
          3. Walking time with support
          4. Walking distance
          5. amount of support needed
          6. Stair climbing: normal, with banister, both feet on each step, unable
          7. Sitting: pain…
          8. Can put shoes and socks on
          9. Can cut toenails
          10. Pain: with first steps only, after long walks, with all activity, all the time
          11. limp
       2. TKA Questions
          
          1. Degree of pain
          2. Timing of pain
          3. Rest pain
          4. Location of pain
          5. Walking time without support
          6. Walking time with support
          7. Walking distance
          8. amount of support needed
          9. General activity level
          10. Stairs
   13. Handedness, Occupation, Sports
   14. ROS
2. Physical Exam
   
   1. Disrobe appropriately
   2. General physical exam including vitals
      
      1. I would look for dysmorphic features, midline or cutaneous lesions and note the pts body habitus
      2. I would inspect the overall alignment including the spine and all extremities
   3. Examine joint above and below
   4. Look
      
      1. Gait
         
         1. including toe and heel walk
      2. S welling
      3. E rythema
      4. A trophy
      5. D eformity
      6. S kin changes
   5. Feel
   6. Move
   7. NV Exam
   8. Special Tests
3. Imaging
   
   1. Xrays
4. Diagnosis or DDx
   
   1. Implications (AVN risk, infection, etc.)
5. Acute Rx and work-up
   
   1. Reduce/splint/traction, ER tests/consults, admit, further imaging, plan OR for trauma
6. Treatment plan
   
   1. I would refer the patient to a ___ specialist
   2. I would explain the nature of the condition and the Goals of Treatment
   3. I would then recommend Non-operative Rx including
      
      1. Options
         
         1. physio
         2. weight loss
         3. activity modification
         4. smoking sessation
         5. medication
      2. Follow-up
         
         1. Return earlier if condition worsens
   4. Given the failure of nonoperative treatment, I would discuss the Operative options with the patient
      
      1. Options
   5. Consent
      
      1. I would obtain informed consent from the patient for “___________”
      2. I would explain the associated
         
         1. Risks both
            
            1. immediate
            2. late
   6. I would the Pre-op the patient obtaining
      
      1. labs (x-match), tests (EKG, CXR), old OR reports, consults
   7. I would Post the case (PoST It First MAn)
      
      1. Patient – “A 45 y.o. male patient undergoing a”
      2. Surgery – “ORIF of …”
      3. Table – “ The patient will be positioned ___ on a ___ table”
      4. Implants – “The instruments required include …”
      5. Flouro
      6. Monitoring
      7. Adjuncts (teams, consultants, special equipment)
7. Technique (PTA SAF)
   
   1. Position
   2. Tourniquet
   3. ABX
   4. Surgical approach
   5. Fixation
8. Post-op
   
   1. In PACU
      
      1. NV exam
      2. Compartment check
      3. obtain Xrays
   2. Physio
      
      1. Immobilization
         
         1. splint
         2. abduction pillow
      2. Weight Bearing Status
      3. Precautions
         
         1. eg. posterior approach
9. Disposition and Follow-up
   
   1. F/U plan
10. Complications
    
    1. List potential complications
    2. Prevention
    3. Treatment