things to remember Flashcards
Pneumonic Template
G R C C P P
Goals
Refer
Conservative – PIMBS
Physio: stretch, strengthen, wt loss, act mod
Injections: intraarticular, blocks
Meds: NSAIDs
Bracing: orthotics
Smoking cessation
Consent: Risks
Preop – LECCORT
Labs
EKG
CxR
Consults
Old OR reports & XRays
Template
PoST It First MAn
Patient
Surgery
Table/position
Instruments
Fluoro
Monitoring
Adjuncts (consults)
PTA
Position
Tourniquet
Antibiotic
VIP
Vascular – NV and Compartment
Immobilization
Physio
Open #:Mx
- irrigate & occlusive dressing
- tetanus
- ABx
- extend surgical wound, sharply debride skin, subcutaneous fat, fascia, muscle, bone of gross and fine contaminants
- 9 L sterile NS under gentle pulse lavage
- closure of surgical wounds, ABx bead pack, 24-48 hr 2nd look
THA:
ANY REVISION R/O INFECTION
- Be sure to refer to Arthroplasty specialist when a revision
- Autologous blood, consent for ICBG
- Pre-op ABx,
- Reversal of anticagulation, stop NSAIDS 10d pre-op
- DVT prophylaxis / W/U w/ Duplex doppler / venogram IVC filter
- HO prophylaxis 700 Gy 24 hrs post op
- Posterior approach:
sciatic n
medial circumflex in quadratus femoris
Femur #:
reamed vs unreamed in chest trauma controversial
manual traction on long radiolucent table w/ 2 assistants vs # table
assess rotation, alignment and length intraoperatively.
length: measure off intact limb on other side using II and radio-opaque ruler.
rotation: normal limb preoperatively and make mental note of ROM to compare, standardize projection of proximal femur on unaffected side with patella in center of knee joint, then, recreate same image on affected proximal femur, once obtained, hold in position with nail insertion jig while distal fragment manipulated into appropriate position so that patella is in center of knee
end of case:
assess leg lengths
rotation
knee ligament stability
femoral neck
NV status / compartments
Vascular injury:
vascular consult +/- angiogram
prep opposite leg for vein graft
shunt if > 6 hrs, fasciotomy also
Rheumatoid Arthritis
- C-spine flexion extension
- Steroid coverage (100 mg IV Solucortef pre and post)
- Stop DMARDS 2 wks prior
- Anesthesia for fibreoptic intubation
Knee Fracture Dislocation
- NVI assessment
- ABI
- Compartments w/ warm ischemia
- Myoglobinuria, so hydrate the kidneys and watch the CK and Cr levels
FLK (Funny Looking Kid)
“I am unsure if this syndrome is associated with AA or c-spine instability, so I would like to get c-spine films including flexion/extension views prior to any operative intervention as well as Anesthesia for possible fibre optic intubation if that is the case”
Cardiac Echo – heart defect
Abdo U/S – kidney assessment
