Surgery Flashcards
Parkland formula
-kg x % of burn x 4 cc LRs
for babies used 4-6 ml/kg/% or can start with 20 ml/kg/hour
Topical tx for burns
default- silver sulfadiazine
deep penetrating burn- mafenide acetate
eyes- triple antibiotic formulation
snake bite tx
CROFAB if a crotalid, or specific antivenom if other
black widow spider bite sx and tx
sx: nausea, vomiting, and muscle cramps
tx: IV calcium gluconate
congenital dysplasia of the hip
dx:
tx:
dx: uneven gluteal folds, hips can be dislocated positeriorly, confirm with a sonogram
tx: splint with a pvlik harness or 6 months
SCFE
Sx:
Dx:
Tx:
Sx: chubby or lanky 13 years old boy, with groin pain, knee pain, or limp.
- when sitting the sole of the foot on the affected side points towards the other foot.
- as the hip is flexed the thigh goes into external rotation and cannot be internally rotated
Dx: X ray
Tx: pinning of the femoral head back in place
septic hip
Sx:
Dx:
Sx: toddlers have a febrile illness and won’t move their hip, hold it in flexion and external rotation
Dx: aspiration of the hip
Osgood-Schlatter disease
Sx: teenagers with pain right over the tibial tubercles, aggravated by contraction of their quads
Tx: RICE
-(if that doesn’t work immobilization with a cast can be used)
supracondylar fracture
Mechanism of injury:
Tx:
Mechanism of injury: hyperextension of the elbow in a child who falls on the hand with the arm extended
Tx: casting or traction, but also need to be closedly monitored due to the danger to the axillary artery and nerve
Anterior vs posterior dislocation of the shoulder
Mechanism:
Anterior- MC shoulder dislocation vs.
Posterior- Rare, occurs after a massive uncoordinated muscle contraction (like epileptic seizure or electrical burn)
Position at presentation:
Both: arm close to body
Anterior- arm externally rotated (like they are going to shake your hand)
Posterior- Arm internally rotated
XRays:
Anterior- AP and lateral
Posterior: Regular XRAYS can miss it, axillary views or scapular views are needed
Colle’s fracture
mechanism:
Sx:
Tx:
mechanism: fall on an outstretched hand (usually in an older woman with osteoporosis)
Sx: “Dinner fork” wrist
Tx: closed reduction
Fracture of the scaphoid
mechanism:
Dx:
Tx:
mechanism: fall on an outstretched hand
Dx: undisplaced fractures will not show up on Xray till 3 weeks later, dx on history and physical
-dysplaced fractures will show up and need internal fixation or risk avascular necrosis
Tx: thumb spica splint for undisplaced fractures
Metacarpal neck fracture
Mechanism:
Tx:
Mechanism: closed fist hits a hard surface
Tx: ulnar gutter splint
Position in a hip fracture vs posterior dislocation of the hip
Both: affected side looks shortened
Hip fracture- Leg externally rotated
Posterior dislocation- Leg internally rotated
Gas gangrene Tx
IV penicillin, surgical debridement, and possibly hyperbaric oxygen
trigger finger
Sx:
Tx:
Sx: acute finger flexion, unable to extend without using the other hand (results in a painful snap)
Tx: steroid injections
De Quervain tenosynovitis
Dx:
Tx:
think *new moms
dx: pain reproduced by holding thumb in a closed fist, and ulnar flexion of the wrist
tx: steroid injections are the most effective tx
Dupuytren contracture
contraction of palm of the hand
* think norwegians and alcoholics
morton’s neuroma
Sx:
Cause:
Sx: inflammation between third and forth toes
neuroma is palpable and tender to palpatation
cause: used of pointed high heels
Ulcer from arterial insufficiency vs venous statis
location:
appearance:
location:
arterial- as far from the heart as possible
venous- above the medial malleolus
appearance:
arterial- pale base, NO granulation tissue (new connective tissue and microvascular that forms on the surface of a wound during healing)
venous- edematous, hyperpigmented with granulating bed
