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38 Cards in this Set
- Front
- Back
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What really is a fat embolism?
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systemic fat globules from fractures that are distributed into tissues and organs after a traumatic skeletal injury
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Where does the fat in a FES travel?
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to the brain or lungs MOSTLY LUNGS
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What bones are usually involved with a fat embolism?
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long bones, tibia, pelvis and ribs
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What are the s/s of fat embolism?
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12 to 72 hours after injury - fat globules transported to the lungs cause a hemorrhagic interstitial pneumonitis that produces the s/s of ARDS
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What is ARDS?
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acute respiratory distress syndrome
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What are the s/s of ARDS?
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chest pain
tachypnea cyanosis dyspnea apprehension tachycardia decrease in pp of 02 changes in mental status petechia (look in armpits) |
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What is the petechia of ARDS caused by?
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causes by intravascular thromboses caused by decreased oxygenation
**THis Petechia is with FE but not with DVT. |
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What are the changes in mental status that are described in a fat embolism?
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memory loss, restlessness, confusion
(Also might have: elevated temp, headache) |
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What is immediate treatment for a FES?
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oxygen - if they are up, get them back in bed, put them sitting upwright and slap oxygen on them
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What is prevention of a FES?
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careful immobilization
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How does PT usually realize that a FE is happening?
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They see a drop in the o2 sat
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What are some ways to prevent DVT?
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SCDs
LMWH moving |
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What do you want to make sure of with a cast in the first couple of hours?
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do not cover it
elevate it up on a pillow above the heart |
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What are the two main things you want to watch for with a fracture?
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infection
compartment syndrome |
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What is main deal with compartment syndrome that you realize it might be coming on?
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pain that is not relieved by analgesics....
pulses down, pain on flexion, might be swelling and tight shiny skin If you get to blue and decreased pulses things are LATE |
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What do you want to make sure of with post op laminectomy?
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they stay aligned
log roll them every 2 hours assess for CSF leaking...infection meningitis. |
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What positions can a laminectomy be in?
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in bed with knees slightly bent or on side with pillow between legs and arms
Not up in a chair!!! |
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What do you have to assess for with spinal surgery?
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bowel and bladder function...nerve damage may be causing incontinence
CSF leakage |
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Pain in lower back can be assessed how?
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usually radiates across buttocks and down posterior leg (sciatica) increases with coughing, sneezing and/or straight leg raising. Diagnostic test is lifting leg straight (this indicates herniated disk vs. muscle strain)
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What are the interventions or conservative treatments for herniated disk?
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rest, corset, heat or ice, TENS unit, NSAIDs and PT
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What are the complications of an amputation?
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fluid accumulation, phantom limb sensation, PTSD, grieving and HEMORRHAGE, and FLEXION CONTACTURES
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What is a disarticulation?
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amputation performed through a joint
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What is an open amputation?
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stump is left open to provide drainage
vs. a closed one where skin flaps are pulled over the bone end and sutured in place. |
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When an amputation is "closed", what type of equipment do you expect to be working with?
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Hemovac or Penrose drain
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What are the important assessments to do for an amputation?
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assess: drainage, wound site, sutures (make sure they don't rupture by keeping on a pressure dressing). Make sure to monitor posterior dressing as well
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When will a patient receive a prosthesis? why?
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After about 3 months they can be weight bearing and receive a fitted prosthesis. The time delay is due to stump shrinkage)
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What type of dressing is placed on an amputation? why?
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a figure eight dressing
it is a compression dressing to prevent hemorrhage and suture ruptures |
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Be sure to educate patient post op amputation about the importance of posture and avoiding this type of sitting position.
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Sitting with stump elevated, sitting for long periods of time, putting a pillow under knee or stump. AVOID CONTRACTURES!!!
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What is osteomyelitis?
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infection of the bone. Usually staph or strep
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How do people develop osteomyelitis?
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Three ways:
blood borne infection from other site direct bone contamination extension of the soft tissue infection (cellulitis) |
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What is the big danger of osteomyelitis?
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SEPSIS & Amputation
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Why is osteomyelitis difficult to treat?
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abx can not treat the infection if it is walled off in a sequestra b/c there is not blood supply
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What makes OM chronic?
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over 1 month of infection that has failed to respond to initial ABX treatment.
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What are the presenting signs of osteomyelitis?
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s/s of infection
swelling, redness, warmth at site pain may be only sign |
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What is an important dx of osteomyelitis?
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a bone scan. The infected area will be really bright due to the increased uptake of radio isotopes
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What will an x-ray of OM look like?
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probably won't show early infection...might show the damage of a chronic or later infection
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What are interventions for OM?
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IV antibiotics (methacillin or oxacillin until c/s return)
Ancef, Keflex once m/o determined ABX treatment will be 4-6 weeks |
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Other than ABX treatment for OM, what else might you expect as an intervention?
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debridement, multiple i/d
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