Virtual Class topics 11-20 Flashcards
Describe UMN disease presentation
In terms of:
Tone
Reflexes
Sensation
Involuntary
Voluntary
Spasticity
Hyperreflexia
Decreased sensation
Muscle spasms
Synergistic movement patterns
Describe LMN disease presentation
In terms of:
Tone
Reflexes
Sensation
Involuntary
Voluntary
Hypotonia
Hyporeflexia
Decreased sensation
Fasciculations
Weak movements
Describe basil ganglia disorder presentation
In terms of:
Tone
Reflexes
Sensation
Involuntary
Voluntary
Rigidity
Decreased or normal reflexes
Normal sensation
Resting tremors
Bradykinesia
Describe cerebellar disorder presentation
Tone
Reflexes
Sensation
Involuntary
Voluntary
In terms of:
Decreased or normal tone
Decreased or normal rexlexes
Normal sensation
No involuntary movements
Ataxia, intention tremor, dysdidochokinesia, dysmetria
Describe the patho of parkinsons
Progressive neurological disorder, degeneration of substantia nigra in midbrain, decrease in dopamine
What are the cardinal signs of parkinsons
TRAP
Tremor at rest
Rigidity
Akinesia / bradykinesia
Postural instability
Describe the Honen and Yahr classification system for parkinsons
Stage 1
Minimal symptoms
Unilateral if present
Stage 2
Bilateral symptoms
Balance not impaired
Stage 3
Impaired righting reflexes
Balance impaired
Some activities impaired
Stage 4
Ambulation only possible with assistance
Stage 5
Bed / wheelchair bound
Describe freezing and festinating gait
Freezing gait
Sudden inability to initiate movement
Walking and then stops
Happens in response to cognitive load
Visual cues to help correct
Festinating gait
Short stride, shuffling, anteropulsion
Correct by adding toe wedge, helps to bring COM backwards and prevents forward leaning
Describe the patho of MS, what demographic group is most at risk
Autoimmune disease.
Immune system attacks the myelin on nerves producing progressive demyelination in the CNS.
Common in women 20-40
What are some unique MS symptoms
Lhermitte’s sign
Neck flexion sends electric shock down spine
Uthoff’s phenomenon
Intolerance to heat
Charcot’s triad - SIN
(Cerebellar symptoms)
Scanning speech
Intentional tremor
Nystagmus
What is marcus gunn pupil
Pupils dilate in response to light rather than constrict, seen in MS
What are the 4 types of MS
Relapse remitting
Attacks with remission
Most common type
Primary progressive
No attacks, constant increase in symptoms
Secondary progressive
Relapse remitting turning into primary progressive
Progressive relapsing
Attacks with constant increase in symptoms
What are some intervention considerations for MS
Do not over fatigue
Manage temperature
Energy conservation
Exercise in best in the morning
Include coordination and balance training
Describe ALS patho and what is its other name
Progressive neurological disorder that damages nerve cells and causes disability.
Involves death of motor neurons.
Lou Gehrig’s disease
Describe ALS presentation in terms of motor, sensory, cognitive, respiratory , and common fatality
UMN and LMN presentation
Normal sensations
Only motor neurons affected
Dementia, cognitive deficits, pseudobulbar affect
Muscles, cervical spine extensor weakness is common
Respiratory muscle weakness which can lead to death
Describe GB
Cause, presentation, prognosis
Autoimmune disorder causing demyelination in the LMN
Occurs after respiratory or gastrointestinal infection
Full recovery possible
Progressive loss of distal to proximal paralysis (ascending paralysis)
Glove and stocking pattern
Describe ACA stroke presentation
ABCD = baby = what do kids do
Hemiparesis LE
Hemisensory loss LE
Urinary incontinence
Problems with imitation, bimanual tasks, apraxia
Slowness, delay, motor inaction
Contralateral grasp reflex, sucking reflex
Describe MCA stroke presentation
MPH, mouth, perception, HH
Hemiparesis UE and face
Hemisensory loss UE and face
Language issues
Visual perceptual deficits
Contralateral HH
Describe PCA stroke presentation
Contralateral HH
Visual agnosia - PROSOPagnosia, Inability to recognize people.
Dyslexia w/o agraphia, color discrimination.
Memory deficits.
Topographical disorientation.
Describe L sided stroke presentation
“OLd”
R hemiparesis and hemisensory
Language impairments
Slow, cautious
Highly distractible
Difficulty with positive emotions
Describe R sided stroke
“Rambunctious”
L hemiparesis and hemisensory loss
Visual perceptual deficits
Quick, impulsive
Rigid thought
Difficulty with negative emotions
Desceibe the brunnstrom stages of motor recovery
1
No active limb movements, flaccid
2
Minimal voluntary movement
Inside synergy, increased tone
3
Voluntary control of movement synergy
Spasticity at peak
Peak tone
4
Movement outside of synergy
Decreased tone
5
Increased independence from synergies
6
Individual joint ,povement
Coordinated movement
7
Normal
Describe the parameters for hot pack administration
158-167 F
20-30 mins
6-8 layers of toweling
Burns likely to happen within 5 minutes
Describe the parameters for parafin bath
125-127 F
15- 20 mins
Used on hands and feet with irregular distal areas
Describe the application and parameters for contrast baths
Immerse in hot and cold water in alternating fashion
Hot water 100-111 F for 4 min
Cold water 55-65 F for 1 mins
Always end with cold
What are the negative anions used during iniontophoresis and what do they do
ISAD
Iodine - Sclerotic scars
Salicylate - Analgesia
Acetate - Calcium deposits
Dexamethasone - Reduce MSK infmallation
What are the positive cations used in iontophoresis and what do they do
WHaCC LiZ
Water - hyperhidrosis
Zinc - dermal ulcers
Lidocaine / xylocaine - analgesia
Copper - fungal infections
Hyaluronidase - edema reduction
Calcium / magnesium - muscle spasms
What are the E-STIM parameters for muscle strengthening
35-50 pps
150-200 micro seconds for small muscles, 200-350 for larger muscles
> 10% to 50% MVIC
6-10 seconds on, 50-120 seconds off, 1:5 normally
2 second ramp time
10-20 min treatment time
Every 2-3 hours when awake
What are the parameters for high voltage pulsed valvanic current for wound healing, in terms of PPS, microseconds, Amplitude, duration and waveform
60-125 pps
40-100 microseconds
Comfortable tingling
45-60 mins
HPVC waveform
When administering high voltage pulsed galvonic current when should a positive or negative electrode be used
Negative electrode - Inflamed or infected wound
Positive electrode - Wounds without inflammation
Describe high rate tens and what is it’s other name
in terms of
Goal
Wave
PPS
pulse duration
amps
tx time
I - When there is acute pain use high rate
G - Goal is sensory stimulation
W - Mono or biphasic pulsed
PPS - 100 pps
PD -50-100 µs
A - Comfortable tingling
T - 20-30 mins, useful when there is pain during functional activities
Conventional tens
Describe low rate tens and what is it’s other name
in terms of
Goal
Wave
PPS
pulse duration
amps
tx time
G - Motor stimulation
W - Mono or biphasic pulsed
PPS - < 10 pps
PD - > 150 µs
A - Visible twitch
T - 20-45 mins
Acupuncture tens
Describe breif intense tens
in terms of
Goal
Wave
PPS
pulse duration
amps
tx time
G - Motor stimulation
W - Mono or biphasic pulsed
PPS - 100 pps
PD - >150 µs
A - Strong muscle contraction
T < 15 mins
Describe noxious tens and what are its use cases
in terms of
Goal
Wave
PPS
pulse duration
amps
tx time
G - Hyperstim
W - DC or monophasic
PPS - 100 PPS or 1-5 PPS
PD - >250 µs up to 1 sec
A - Highest tolerance
T - 30-60 sec per area
Trigger point release
Describe the US decision making tree for chronic pain
Thermal
100% duty cycle
5 - 10 mins
Depth:
- 1-2cm = 3MHz = .5 W/cm2
- 3-5cm = 1MHz = 1.5-2 W/cm2
Describe the US decision making tree for acute pain
Nonthermal
20% duty
5-10 mins
Depth
- 1-2cm = 3MHz = 0.5-1 W/cm2
- 3-5cm = 1MHz = 0.5-1 W/cm2
Describe traction parameters
Prone
- posterior disk herniation
Supine
- Intervertebral joints, facet joints, muscle elongation
- L3-L4: 75-90 hip flexion
- L5-S1: 45-60 hip flexion
- 25% body weight: Disc protrusion, spasm, elongation
- 50lb or 50% bodyweight: Joint distraction
Describe the parameters for EMG biofeedback
Relaxing muscles
- Low sensitivity
- Electrodes placed close together
Re-educating muscles
- High sensitivity
- Electrodes placed far apart
What are the diagnostic criteria for metabolic disorder
3 or more of the fallowing:
- Waist circumference > 40 in men, > 35 in women
- HDL < 40 in men, < 50 in women
- Triglycerides > 150
- BP - > 130/85
- Fasting glucose > 100
What fasting glucose level suggests diabetes
fasting glucose greater than 126
What hormones are secreted by the anterior pituitary and what do they do
ACTH - Adrenal cortex - cortisol, aldosterone
TSH - thyroid gland - T3, T4
FSH and LH - ovaries and testes - estrogen, progesterone, testosterone
GH - Bones and tissues - growth and metabolism
Prolactin - milk production in breasts
What hormones are secreted by the posterior pituitary and what do they do
ADH / vasopressin - Regulates water and mineral balance, water retention
Oxytocin - stimulates uterine contraction during birth
Describe addison’s disease
Decreased cortisol and aldosterone
Caused by infections, neoplasm, hemorrhage, autoimmune process.
(Cort)
Decreased BP
Decreased glucose.
Stress, anxiety, depression.
(Ald)
Hyperkalemia.
Dehydration.
Bronze pigmented skin.
Weight loss, anorexia, GI issues.
Generalized weakness.
Cold intolerance
Describe cushing’s disease
Elevated cortisol and aldosterone.
Caused by pituitary tumor.
(Cort)
Increased BP, water retention.
Increased glucose.
(Ald)
Hypokalemia.
water retention.
Ruddy appearance.
Weight gain, obesity, round moon face.
Proximal muscle weakness and atrophy.
Increased susceptibility to infection, osteoporosis, poor wound healing.
Describe hyperthryoidism
HR, BP, BMR, temp tolerance, glucose, energy, GI, lbs, DTR, appearance
Hyperthyroidism - Hype man (all metabolic processes increase).
Increased T3 and T4.
Increased HR.
High BMR.
Heat intolerance. (already running hot)
Increased glucose absorption.
Restlessness, insomnia.
Diarrhea.
Silky hair, moist palm.
Weight loss and increased appetite.
Increased perspiration.
Hyperreflexia.
Exophthalmos (bulging eyes), graves disease.
Describe hypothyroidism
HR, BP, BMR, temp tolerance, glucose, energy, GI, lbs, DTR, appearance
Hypothyroidism - laying on couch all day (all metabolic processes decrease).
Decreased T3 and T4.
Decreased HR, increased BP.
Low BMR.
Cold intolerance. (already running cold)
Decreased glucose absorption.
Sleepiness, tired, proximal muscle weakness
Constipation.
Brittle nails, dry skin and hair.
Weight gain and decreased appetite.
Decreased perspiration.
Prolonged tendon reflexes.
Myxedema (swelling of hands, feet, face), hashimoto’s disease.
Describe hyperparathyroidism
Elevated calcium and decreased phosphate in blood
Bones - Osteopenia, gout, arthralgia
Stones - Kidney, renal insuficiency
Groans - Peptic ulcer
Moans - Proximal muscle weakness, fatigue, drowsiness, depression
Sensory - Glove/stocking sensory loss
Describe hypoparathyroidism
Low calcium and high phosphate in blood
CATS are NUMB
- Convulsions
- Arrhythmias
- Tetany, twitching
- Spasms, cramps
- Numbness in fingertips and mouth area
- Also fatigue and weakness
Describe hypoglycemia
Cold and clammy requieres candy
< 70 blood glucose
Tachycardia and palpitations
Excessive hunger
Dizziness, fainting
Pale, sweating
Shakiness
Poor coordination and unsteady gait
Slurred speech, drowsiness, confusion
Loss of consciousness and coma - call 911
Describe hyperglycemia
> 300 blood glucose
Deep and rapid respirations
Frequent, scant urination
Excessive thirst
Weakness
Dry mouth
Dull senses, confusion, diminished reflexes
Fruity odor breath
Hyperglycemic coma - 911
How does insulin injectiion affect when to exercise
Avoid exercise 2-4 hours after injection
Describe blood glucose levels and safety for exercise
100-250 = safe
70-100 = carb snack
250-300 w/o DKA = caution
250-300 w/ DKA = stop exercise
< 70 or > 300 = stop exercise
What is normal HBA1C and when is insulin therapy needed
Normal = 4-6%
Immediate insulin therapy needed at >10%
What is the FITT for diabetes and exercise
3-7 days
11-13 RPE
150 mins a week
Moderate intensity aerobic exercise involving large muscle groups
Describe the different types of urinary incontinance
Stress - physical stress - strengthen pelvic floor muscles
Urge - hyperreflexive bladder - treat infections, voiding schedule
Overflow - too much, dribbling present - behavioral modification like double voiding, catheter, medication
Functional - bladder functioning normally but other reason why pt cannot void properly, clear environment, improve accessibility, promote voiding
What are some physiological changes associated with pregnancy
20-30 lb weight gain
Forwared head posture, increased lordosis, anterior pelvic tilt
BP low in first 2 trimersters, high in last
HR increases
Describe preeclampsia
Pregnancy induced acute hypertension after the 20th week of pregnancy
BP higher than 140/90 sustained for 4 hours
Also common: Increase protein in urine, hyperreflexia, edema, headache and sudden weight gain
Call 911 this is an emergency
Describe eclampsia
Seizures occuring after the mother gives birth
Describe diastasis recti
Splitting of the rectus abdominus away from the linea alba.
Common in post partum women
Describe treatment for diastasis recti
> 2 cm - bracing or stabilizing
3-4 - bracing + head life, progressing to posterior pelvic tilt
4 cm - bracing + breathing
Describe GERD and symptoms
Reflux of gastric content into the esophagus
Caused by lower esophageal sphincter pathology
Heart burn 30 mins after eating
Sour taste in mouth, dysphagia, hoarse voice, atypical pain of the head and neck
What are some treatment stretegies for GERD
Positioning:
Maintain upright position, avoid supine, sleep on L side
Diet and exercise:
Eat meals 3-4 hours before sleep
Exercise before eating or 2-3 hours after
Avoid spicy, chocolate, fatty foods
Drugs:
Antacids, H2 receptor blockers, proton pump inhibitors
What visceral structures refer pain to the mid back
Esophagus
Stomach
Pancreas
Gallbladder
What visceral structures refer pain to the left shoulder
Heart
Diapgragm
Spleen
Tail of pancreas
What visceral structures refer pain to the right shoulder
Gallbladder
Liver
Head of pancreas
What visceral structures refer pain to the pelvis/low back/sacrum
Colon
Appendix
Pelvic viscera
What pathologies can refer pain to the RUQ
Peptic ulcers
Gallbladder pathology
Head of the pancreas
What pathologies can refer pain to the LUQ
Tail of pancreas
Spleen pathology
What pathologies can refer pain to the RLQ
Appendix
Crohn’s disease
What pathologies can refer pain to the LLQ
Diverticulitis
Ulcerative colitis
IBS
Describe the different types of hernias and their pain refferal pattern
Hiatal hernia
Hernia of stomach up through the diaphragm
Causes shoulder pain
Femoral hernia
Lateral pelvic wall pain and groin pain
Inguinal hernia
Groin pain
Umbilical hernia
Causes pain around the umbilical ring in the mid to lower abdomen
Describe cholecystitis
Blockage of gallstones in the cystic duct resulting in inflammation of the gallbladder
Pain in RUQ, right shoulder and right scapula
Nausea, vomiting, low grade fever
Pain increases with ingestion of fatty food
Test: Murphy sign - Pain w/ palpation and inhilation on R constal margin
Describe the types of peptic ulcers
Gastric ulcer
Lesions in the stomach, caused by chronic NSAID use, stress, anxiety, infections
Pain when food present due to acid secretion, pain after eating
Pain relieved with antacids, medically treating infections
Duodenal ulcers
Ulcerative lesions in the duodenum
Pain when no food present, early in morning, between meals
Pain relieved by medically treating infection
Both:
Burning, cramping in epigastric area, can refer to R shoulder
Coffee ground emesis and dark tarry stools are characteristic
Describe the two types of IBD
Ulcerative colitis - LLQ
Only large intestine and rectum affected
Continuous lesion
Rectal pain, bleeding, bloody diarrhea with mucus / pus, fecal urgency, weight loss, LBP
LLQ pain
Crohn’s disease - RLQ
Anywhere in GI tract
Skip lesions
Pain relieved by passing gas, abdominal pain, weight loss, joint arthritis
RLQ
Describe IBS
Spastic, nervous or irritable colon
Caused by Emotional stress, anxiety, high fat, lactose foods
LLQ pain
Pain relieved by defecation
Ribbon like stools
Sharp cramps in the morning or after eating
Symptoms disappear while sleeping
Describe appendicitis
Inflammation of the vermiform appendix
Pain in RLQ, comes in waves
Anorexia, elevated temperature, leukocytosis, fever
Tests:
- Tender at McBurney’s point
- rebound tenderness (bloomberg sign)
- Psoas sign
- Obturator sign
- Single leg hop test
- Merkel sign - landing on heels from toes
Immediate medical attention required if confirmed
Describe where the spinal cord ends
Ends at T12
Conus medularis at L1
Cauda equina L2 and down
Describe the DCML
Dorsal column medial lemnicus
Ascends ipsilateral
Proprioception
Vibration
fine touch
Graphesthesia
Bargognosis
Sterognosis
Describe the ALS tract
Anterior spinothalamic tract
Ascends contralateral
Pain
Temperature
Crude touch
Describe posterior cord syndrome
Loss of bilateral DCML
Caused most commonly by iatrogenic means
Describe anterior cord syndrome
Loss of ALS and corticospinal tract bilaterally
Commonly caused by hyperflexion injury
Describe brown sequard syndrome
Ipsilateral loss of CST and DCML
Contralateral loss of ALS
Commonly caused by knife wounds, GSW
Describe central cord syndrome
Small lesions: bilateral ALS loss
Large lesions: All lost bilaterally, LE spared somewhat, ambulaton possible
Commonly caused by hyperextension injuries
Describe conus medularis and caudaequina syndrome
Conus
LMN+UMN symptoms
Bilateral symptoms in perineum and thighs
Saddle anesthesia, bilateral symmetric
Symmetric motor loss
Cauda equina
LMN sign
Unilateral and asymmetric symptoms in perineum, thighs, leg and back
Saddle anesthesia, unilateral, asymmetric
Describe the ASIA muscle groups
C5 - elbow flexors
C6 - Wrist extensors
C7 - Elbow extensors
C8 - finger flexors
T1 - fifth finger abductors
L2 - hip flexors
L3 - Knee extensors
L4 - Ankle dorsiflexors
L5 - Long toe extensors
S1 - Ankle plantar flexors
Describe how to identify the lowest motor and sensory level during an ASIA exam
Motor level
Lowest level that has 3/5 AND everything above has to be 5/5
Sensory level
Lowest level where score is 2/2 AND everything else above is 2/2
Describe the NLI
Most caudal level with motor AND sensory function intact
Describe the ASIA impairment scale
A
Complete
No motor or sensory at S4-S5 level
B
Sensory incomplete
Sensory but no motor below NLI and S4-S5
C
Motor incomplete
Most muscles below NLI have below 3/5 strength
D
Motor incomplete
Most muscles below NLI have above 3/5 strength
E
Motor and sensory normal
What are some complications related to SCI
Orthostatic hypotension
Tone
Respiratory dysfunction
Autonomic dysreflexia
Describe the preserved respiratory muscles for the various SCI levels and how to manage respiratory functon
C1-C2 - SCM, upper traps - treat with phrenic nerve stimulator and ventilator
C3-C4 - Partial diaphragm, scalene - treat with ventilator, glossopharyngeal breathing
C5-C8 - Diaphragm - Weak cough
Describe spastic and flaccid bladders
UMN spastic bladder
Seen above S2 spinal level, T12 vertebral
Intermittent catheterization every 3-6 hours
Suprapubic tapping - helps the pt void
LMN flaccid bladder
Seen in S2 spinal level or below, L1 vertebral
Require intermittent catheterization every 3-6 hours
Valsalva or crede’s maneuver
Crede (Pushing on abdomen)
Describe the functional capacity of a C1-C4 level SCI
Dependent for everything
Mechanical ventilation
Mobility:
Mechanical lift transfer
Powered WC, head, shin and mouth control
Describe the functional capacity of a C5-C6 level SCI
Modified independence
Can be independent but modifications and equipment required
Mobility
C5 - dependent slide board
C6 - independent slide board
Both - Manual WC, plastic coated handrims
Describe the functional capacity of a C7-C8 level SCI
Beginning of independence
Mobility
IND w/o device for even transfers
Dep w/ SB for uneven transfers
C8 - may be able to do floor to WC transfer
Manual WC, plastic coated handrims
Independent on even surfaces, not on ramps
C8 - independent on ramps and surfaces
Describe what transferes are posible at various thoracic SCI levels, when is stand pivot possible
T1
Floor to WC transfer
Independent w/ WC
T4
Sitting pivot transfer
Independent w/ WC
L3
Standing pivot transfer
Independent w/ WC
Describe ambulation expectations regarding various SCI level injuries
T level 1-12
Standing w/ HKAFO and crutches
L1-L3
Bilateral KAFO and crutches
L4-S2
Bilateral AFO and crutches or cane
Describe RLA SCI levels 1-3
1 - No response
Coma
2 - Generalized response
Whole body responds to stimulus
3 - Localized response
Local response, inconsistent
Follows simple commands, open close eyes
Describe RLA SCI levels 4-6
4 -Confused agitated
Heightened activity, aggressive, does not cooperate, verbalization is incoherent, confabulous
No selective attention
No-long term and short term memory
5 - Confused inappropriate
Consistent response to simple commands
Confabulations
Inconsistent response to complex commands
Able to socialize for short periods of time
Memory impaired
6 - Confused appropriate
Follow simple commands consistently
Memory begins to improve
Goal oriented behavior
Describe RLA SCI levels 7-8
7 - Automatic appropriate
Oriented
Daily routine is robot like
Judgment impaired
Social interaction improved
8 - Purposeful appropriate
Learning possible
Impaired judgment in emergency situations
Return to previous level of function
Describe which nerve endings perform what function
Regarding:
Meissner
Merkle
Krause
Ruffini
Pacinian
GTO
Meissner Corpuscles - Fine touch
Merkle disks - Crude touch
Krause end bulbs - Cold sensation
Ruffini endings - Hot sensation
Pacinian corpuscles - Pressure
Golgi tendon organs - Stretch reflex
Describe venous wounds
Proximal to medial malleolus
Irregular, shallow
Flaking, brownish discoloration - hemosiderin staining
Mild to moderate pain
Elevation decreases pain
Describe arterial wounds
Lower ⅓ of leg, toe, lateral malleolus
Smooth edges, well defined, deep
Thin and shiny, hair loss, yellow nails
Severe pain - due to lack of blood
Elevation increases pain
Describe herpes zoster
Initial symptoms of pain and paresthesia localized to the affected dermatomes
Present as rash
Mostly unilateral
Raised to palpation
Pink with silvery white appearance
Describe herpes simplex
Type 1
Cold sores above the belt and around the mouth
Type 2
Cold sores below the belt
Describe the following terms
Blster
Vesicles
Wheals
Pustules
Blisters:
Common Blister
Vesicles:
Lesion that is filled with fluid 0.5 or less, Bullae if more
Wheals:
Like hives
Irregular, edematous, itchy
Pustules:
Inflamed, puss filled
Describe which types of derssings to use for increasingly exudative wounds
No to scant exudate - transparent films
Minimal exudate - hydrogel, hydrocolloid
Moderate exudate - foam
Heavy exudate - calcium alginate, hydrofiber
Describe some selective and nonselective debridement strategies and when to use them
Selective - used when leess than 50% necrosis
Sharp
Enzymatic
Autolytic debridement
Nonselective
Wet to dry dressings
Wound irrigation - moves necrotic tissue from wound bed uring pressurized wound
Hydrotherapy - use of whirlpool with agitation directed toward a wound requiring debridement
Describe the uses of the following
Sterile normal saline
Povidone
Zinc oxide
Nitrofurazone
Sterile normal saline
Useful initial agent to clean wounds
Povidone - iodine solution
Surgical
Zinc oxide
Dental
Nitrofurazone
Infected burns and skin
Describe the types of scars
Normal - flat and similar to skin color
Hypertrophic scar - healed wound with thick fibrous tissue that remains within original wound border
Keloid - excessive scar tissue grown outside of the original margins of the wound
Describe the rule of nines and how it is adated to kids
Adults
Head - 4.5%
Torso - 18%
Arms 4.5%
Legs 9%
Perinium 1%
Kids
Head - 8.5%
Torso - 18%
Arms 4.5%
Legs 6.5%
Perinium 1%
