Week 4 Flashcards
Puerperal sepsis is defined as an infection of the _______ occurring at any time between __________ or _______ and _____________\
genital tract
rupture of membrane
labour
42 days postpartum
Full meaning of CTTD
Closed tube Thoracostomy drainage
A chest tube is a surgical drain that is inserted through the _______ and into the _________ or the ________ in order to remove clinically undesired substances such as ______________ , excess fluid (__________ or __________), blood (hemothorax), chyle ( _________ ) or pus ( ____________ ) from the intrathoracic space.
chest wall; pleural space; mediastinum
air (pneumothorax)
pleural effusion or hydrothorax
chylothorax; empyema
Contraindications to chest tube placement include _____________ and presence of a _______________, as well as hepatic _________________.
Additional contraindications include ___________ in the pleural space (____________).
refractory coagulopathy
diaphragmatic hernia
hydrothorax
scarring; adhesions
Contraindications to chest tube placement include _____________ and presence of a _______________, as well as hepatic _________________.
Additional contraindications include ___________ in the pleural space (____________).
refractory coagulopathy
diaphragmatic hernia
hydrothorax
scarring; adhesions
Refractory coagulopathy, defined as ______________ from multiple sites despite ___________________
continued bleeding
ongoing blood component administration
Scaling of pain
0-
2-
4-
6-
8-
10-
No pain
Mild pain
Moderate pain
Severe pain
Very severe pain
Worst pain imaginable
Spondylosis is _____-related change of the bones (vertebrae) and discs of the spine. These changes are often called __________ disease and __________. When this condition is in the ________, it’s called lumbar spondylosis.
age
degenerative disc; osteoarthritis
lower back
Osteopenia is a loss of ________________ that weakens bones. It’s more common in people older than ______, especially _______
bone mineral density (BMD)
50; women
PRN medications: The acronym PRN ( ___________ ) refers to preparations that are prescribed to be administered on _____________ rather then at ___________
Pro re nata
an as needed basis
scheduled intervals.
Parts of a long bone?
Articular Cartilage
Proximal epiphysis
Epiphyseal line
Metaphysis
Diphysis
Metaphysis
Distal epiphysis
Articular cartilage
Ossification centers of the elbow!
Capitellum
Radial head
Internal(medial) epicondyle
Trochlea
Olecranon
External (lateral) epicondyle
Compartment syndrome is defined as a _______________ within a confined compartmental space.
critical pressure increase
Compartment syndrome typically occurs following _____-energy trauma, _____ injuries, or _______ that cause vascular injury.
Other causes include iatrogenic vascular injury, ————- or _________ , ___________, and post-reperfusion swelling.
high; crush; fractures
tight casts or splints
deep vein thrombosis
In compartment syndrome , the ______ are first compromised, followed by the ————- therefore leading to _______, and then the _________ are compromised and the limb becomes ________
Veins; traversing nerves
Paresthesia
Artery
Ischemic
Clinical Features of compartment syndrome
Symptoms tend to present within ______, although it can develop up to ________ post-insult.
hours; 48 hours
The most reliable symptom of compartment syndrome is __________, disproportionate to the injury, which is not readily improved with initial measures and made worse by ________________________ traversing the affected fascial compartment.
_________ can occur, however whilst the patient may have had a neuropraxia at the time of the injury, it is the presence of evolving neurology that is most important
severe pain
passively stretching the muscle bellies
Parasthesia
In compartment syndrome
The affected compartment may feel ______ (compared to the contralateral side), but will not generally be _______ (as the fascial compartment is only ______).
tense; swollen
minimally distensible
Acute limb ischemia
often referred to as the ‘5 P’s’):
__________,__________, ____________, _________, __________
Pain ,Pallor , Perishingly cold, Paralysis, and Pulselessness.
Compartment syndrome is most common in the _______ limbs
lower
Compartment syndrome
Definitive treatment is with an emergency ___________
open fasciotomy
Fasciotomy, a procedure in which the __________ to __________ in the ________ compartment
fascia is cut
relieve pressure
muscle
A fracture is ‘open’ when there is a direct communication between _______________________.
This is most often through the _______ – however, pelvic fractures may be internally open, having penetrated in to the _________ or _________
the fracture site and the external environment
skin
vagina or rectum.
Radiological rule of 2??
2 views( AP and L)
2 joints (one above and one below)
2 times
2 sides
Cast is _______
Slab is __________
Hard
Soft in some parts
POP is very _______, but _______ with time . It is (aerated or not aerated?) and affected by __________
Heavy; weakens
Not aerated
Moisture
Scotch VS POP
scotch is made from ———-, POP is made from ________
Scotch is (lighter or heavier?)
Scotch is (stronger or weaker?)
Scotch is (cheaper or more expensive?)
Scotch is (aerated or not aerated?)
Scotch is affected by moisture (T/F?)
Fiberoptics; calcium gypsona
Lighter; stronger; more expensive
Aerated; F
Skin and skeletal traction are mostly indicated for _______- fracture and issue related with the ______
proximal femoral
hip
Period of primary bone healing
Children: ____ for UL; _____ for LL
Adults : ____ for UL; _____ for LL
3weeks; 6 weeks
6weeks; 12weeks
Stages of fracture healing
????
Haematoma formation
Inflammation
Proliferation of osteoblasts, neocascularization
Spongy callus
Bony callus
Remodelling
Ambulant means to??
Be mobile
To walk around
Malunion:
Delayed union :
Non-union:
Healed in abnormal anatomic position
Failure of primary bone healing to occur at 3 months
Healing fails to occur after 9months
7 Ps of compartment syndrome???
Pain
Paresthesias
Pallor
Poikilothermic
Paralysis
Pulselessness
Putrefaction
In compartment syndrome, ensure elevation of the affected limb
T/F
F
Avoid elevation of the limb
In late treatment of lower limb injuries, it might be safer to __________, as dead muscle tends to produce ________ which leads to ________ with ______ blockage and _________
Amputate
Myoglobin; myoglobinuria ; glomerular
Renal failure
Indications for amputation?
Dead or dying limb
Dangerous limb
Dammed nuisance
How to know it’s a sequestrum?
You won’t be able to see the medullary cavity
A cloaca in bone is a ____________ of a bone affected by chronic osteomyelitis
gap in the cortex
Following healing , recurrence is common in _________ ulcers
Venous
Venous disease is responsible for _______% of all ulcers in the lower leg
60-70
Majority of ulcers develop in the _____ side of ulcers
Venous Ulcers rarely extend into ________ or _______
Medial
Foot or upper calf
Wagner grading of Ulcers
0-
1-
2-
3-
4-
5-
At risk; pre-ulcer
Superficial ulcer: skin and subcut tissue
Deeper to subcut, expose soft tissue, bone
Abscess formation
Gangrene of part
Gangrene of whole area
Spurious hematuria is ???
False hematuria
causes of spurious hematuria include _____________ and ___________ in women.
urinary contamination from menstruation and sexual intercourse
A normal range of PCV
In females, _______ to ____%.
In males, ____% to _____%
35.5 to 44.9%.
In males, 38.3% to 48.6%
The normal Hb level for males is _____ to _____/dl; that for females is _____ to _____ g/dl
14 to 18 g/dl
12 to 16 g/dl
A normal platelet count in adults ??
A normal wbc count in adults?
A normal rbc count in adults?
150,000 to 450,000 platelets per microliter of blood
4000-11000 wbc per microliter
4.5-5 million rbc per microliter
Normal PSA level?
0-4ng/ml
A trimodal distribution of trauma deaths describes three peaks of deaths following trauma: ———,_______, and _________ deaths.
immediate, early and late
Immediate death
(Occurs within _______ of injury)
Early death
(Occurs within ___________)
Late death
(Occurs _________ after injury)
minutes
hours of arrival into hospital
day to week
Causes of immediate death
____________ injury
___________ from injuries
Irreversible brain
Hemorrhage
Triage TAGS
Red (________) – _____________ injury patients
Yellow ( _________ )-_________ injured patients
Green (__________ patient) – ________________ injury
Black (_________) – _____________ patients
immediate; Most critical
Delayed; Less critically
ambulatory; No life or limb threatening
expectant; dead or moribund
Factors used in TRIAGE
Mnemonic??
Full thing??
SLUT
Severity of injury
Likelihood of survival
Urgency of care
Deadly six fall under ???
Immediate or early or late causes of death?
Early
A crystalloid fluid is an ________ solution of ________ and other small, water-soluble molecules.
aqueous
mineral salts
Other commercially available crystalloid fluids include:
____________
__________/__________ solution (lactate buffered solution)
__________ solution.
________ and _________solution.
Acetate and gluconate buffered solution.
__________(hypotonic solution)
________ (hypertonic solution)
___________ in water.
Normal saline
Lactated Ringer’s/Hartman’s
Acetate buffered
Acetate and lactate buffered
0.45% NaCl
3% NaCl
5% Dextrose
Assessment of airways?
Assessment of breathing?
Voice, breath sounds
Respiratory rate, chest wall movements,lung auscultation, pulse oximetry
Assessment of Circulation
Skin color, sweating , pulse rate, capillary refill time ,blood pressure, heart auscultation
The normal pulse for healthy adults ranges from ____ to _____ beats per minute.
The normal respiratory rate for an adult at rest is _____ to _____ breaths per minute
Normal SPO2 is ???
60 to 100
12 to 20
97-100%
Tetanus antiserum provides (temporary or permanent ?) (active or passive?) immunity against tetanus for _______
Temporary
Passive
2 weeks.
Anti Tetanus Serum I.P.(A T S)
It is used for _______________ Tetanus. ATS is a solution of purified antibodies prepared from ___________
both preventing and curing
Equine Blood.
Various interventions have been utilized for prophylaxis of ______________(VTE) .
These include mechanical devices such as _________________ (GCS), _____________ (IPC) devices, and pharmacologic agents such as unfractionated heparin, low-molecular-weight heparin, and fondaparinux.
venous thromboembolism
graduated compression stockings
intermittent pneumatic compression
Remember that halving airway radius leads to a _____ fold increase in resistance ( ____________ law)
16; Poiseuille’s
A/An ___________ sample is key to appreciating the clinical state and subsequent efficacy of treatment in patients with respiratory compromise
arterial blood gas (ABG)
If you think your patient is not breathing effectively or at all but still has a pulse, then this is a _____________ and immediate help in the form of a cardiac arrest team should be sought while you and a colleague use a bag-valve-mask to oxygenate the patient.
respiratory arrest
When transfusing in a state of shock, Be careful not to run through bags with added ___________ ‘stat’, as rapid boluses of ________ can cause cardiac arrest.
potassium chloride; potassium
‘Pinpoint’ or bilaterally constricted pupils (miosis) may indicate __________
Anisocoria (a__________________ pupil) can occur with ___________________ , affecting ————-
opioid toxicity
unilaterally dilated (mydriasis)
rising intracranial pressure
CN III
Myositis ossificans is a reaction to a ____________ that has been injured.
During the healing of the bruise, _________ can become deposited in the bruise causing a ___________ within the ________.
bruise in a muscle
calcium; hard bone like structure
muscle
Infection vs Colonization
Infection means that germs are in or on the body and __________, which results in _______ and _______
Colonization means germs are on the body but ____________. People who are colonized will have _____________
make you sick; signs and symptoms
do not make you sick; no signs or symptoms.
Pathogenesis of osteomyelitis
Blood stream invasion in children
Infection starts in the vascular _________ of the long bone (due to arrangement of the blood vessels at that area) >- __________
Relative _________ and consequent lowered _________ favour the bacteria
• Structure of the vessels in this area also allow bacteria to move more easily through and to adhere
metaphysis; hairpin loops
vascular stasis; Oxygen tension
Pathogenesis of osteomyelitis
In adult
• Haematogenous spread account for only ______%
• Affect mostly the ________
20
vertebrae
PATHOGENESIS
• Progress of acute OM
• _________ - __________ - Bone _________ - Reactive _____________ which could either lead to
• _____________ or ____________
Inflammation
Suppuration
Bone necrosis
new bone formation
Resolution and healing
Intractable chronicity
Differential diagnosis of acute osteomyelitis
• ________
• Acute _____________
• Streptococal ______________
• ________________
Cellulitis
• Acute suppurative arthritis
• Streptococal necrotizing myositis
• Sickle cell crisis
Complications of acute OM
•________________
•____________ fracture
•_________ infection
• Suppurative ________
•___________ damage
Chronic osteomyelitis
Pathological
Metastatic
arthritis
Epiphyseal
Subacute osteomyelitis
_________ than acute om
organisms are (more or less?) virulent or patient (more or less ?) resistant
Milder
Less; more
Subacute OM is a rare occurrence
T/F
F
No longer rare
Subacute OM
haematogeneous
Pathology - well defined _____ in __________- _______ abscess
cavity
cancellous bone
brodie’s abscess
Clinical features of Subacute OM
Pain near ______ for ________
__________
Slight _________, muscle ________, local ____________
Temperature is _______
Joint; several weeks
Limping; swelling; wasting
tenderness; normal
Diagnosing chronic osteomyelitis
Recurrent ______________
Previously _______________
Occasional _________________
discharging sinus
healed scars
acute flare
Saucerization
an operation in which ________ to form a saucer-like __________
Usually done when ______ is infected .
tissue is cut away from a wound
depression
Bone
management of chronic OM
Antibiotics
• Local treatment
• Operations
•Wound debridement:________,________
+ _________ Management
•_________
saucerizations
sequestrectomy
dead space
amputation
Treatment of subacute OM
- __________ and _________
•_______ may be necessary
immobilization and antibiotics
Curretage
Bone curettage refers to the removal of bone through that act of _____________
scraping it with a curette.
