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66 Cards in this Set

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Pre-op note consists of:
-32 yo AAF presents for surgical correction of her painful bunion left foot. condition has not resolved with conservative therapy.
-Sx H
-Foot xrays
-chest xray; no active lung dz
-ECG; normal sinus rhythm
-Impression: HAV deformity left foot
-Plan; pt cleared for procedure as per Dr X, consent signed
Post op note consists of
-preop dx
-post op dx
-anesthesia (general, spinal, local)
-hemostasis (mmHg, time)
-estmated blood loss
-materials (suture, drains, fixation)
-injectables (abx, lidocaine)
-pathology (bone, soft tissue, foriegn)
-condition (stable, fair)
Post Op / Admission Orders
-Admit to service of Dr...
-Condition (stable)
-Vitals (i.e monitor vitals q shift as per floor protocol)
-Activity (i.e bedrest)
-Nursing (elevate left leg)
-Ins/Outs (fluid maintentance)
-Ancillary personell (PT, Socialwork)
Inpatient Progress Note
Date, Time
exampled of Subjective part of inpatient Progress note
-pt visited at bedside, offers no complaints. pt denies SOB, chest pain, cough, calf/thigh pain. Good appetite. -N/V, -abd pain, +void, + BM
what is the normal temperature range
97-99.5 F
what can trigger malignant hyperthermia (temp >100)
-inhalation agents such as ether, halothane, enflurane
-NM blockers like succinylcholine
symptoms of malignant hyperthermia
-first sign is arrythmias
-masseter muscle spasm
-rapidly rising temp
-metabolic and respiratory acidosis
-dark, mottled skin
-hyperkalemia leading to cardiac dysarythmias
-elevated CPK levels
-myoglobin release
treatment of malignant hyperthermia
-stop anesthesia
-hyperventilate with 100% O2
-correct the acidosis
-cool the patient
what is dantrolene
-muscle relaxant that prevents the release of calcium
what is the pneumonic for post op fever causes
-Wind, Walk, Water, Wound, Wonder Drugs
-Wind (12-24 hrs postop); atelectasis, pneumonia
-Walk (24hrs); thrombophelbitis, PE
-Water(48hrs); UTI
-Wound (72hrs); post op wound infection
-Wonder Drugs; drug fever
what should Hct/Hb be for elective sx to take place
Hct >40%
Hbg >10 gm
what should be given to pts before a transfusion
-50mg benadryl and 650mg Tylenol
what lab test do you use to determine platelet deficiency
-platelet count
what lab test do you use to determine platelet fxn
-bleeding time
what factors does PT lab test evaluate
what factors does PTT lab test evaluate
mild to moderate HTN is not a significant risk for sx if the BP is...
-if the distolic BP is stable and <110 mmHg
in what direction should you prep an area for anesthesia injection
-distal to proximal
where do you enter for a Popliteal block and how much LA do you use
-2 inches above the popliteal skin crease, medial to teh biceps femoris tendon(lateral tendon)
-30-40 cc's
Common peroneal nerve block; where do you enter and how much LA do you use
-it is very superficial nerve, so palpate the fibular head and enter lateral adn 2 cm distal to fibular head
-3-6 cc's
why would you do a common peroneal nerve block
-diagnostic for asessing spastic peroneal muscles or for stress inversion xrays for lateral ankle instability
list the nerves blocked in an ankle block
-posterior tibial
-superficial peroneal (int/medial dorsal cutaneous)
-deep peroneal
what nerves are blocked with a mayo block
-deep peroneal
-1st proper digital branch of medial dorsal cutaneous
-first proper digital nerve of MPN
-second proper digital nerve od MPN
what nerves are blocked with a hallux block
-first proper digital branch of the medial dorsal cutaneous and first proper digital nerve of the MPN
-deep peroneal proper digital branch to the hallux and 2nd proper digital branch of the MPN
what do osteoclasts do; be specific
-large cells located in the tip of the cutting cone which dissolves bone matrix and forms canals through existing bone
-responsible for new bone formation
what is osteoid
-non calcified organic matrix formed by osteoblasts
-contains collagen and proteoglycans
-osteoid becomes bone via mineralization
-process in which osteoid becomes bone
-osteoid is deposited with crystalline hydroxyapatite to form bone
what is woven bone
-type of bone that forms healing bone callus
-disordered array of collagen fibrils
-eventually remodels to form lamellar bone
what is lamellar bone
-highly organized bone laid down in congruent layers with paralell collagen fibrils
list the stages of bone healing and how long each lasts
-Inflammation(day1-4);intial hematoma and necrosis of bone margins
-induction(unknown duration); callus develops from hematoma
-soft callus(day4-4wks);clinical union w/elimination of motion across site
-hard callus (4wks-4mths); callus converted to mature lamellar bone
healing that occurs when bone fragments are immobilized and callus formation is absent
-primary (direct healing)
-example is a plate
what type of healing occurs when a bone isnt immobilized
-secondary healing; motion allows for additional hemorrhage favoring fibrocartilage thus callus formation
how will a fracture show up on Tc-99m bone scan at 1 week, 4 weeks and 2 years
-week1-4; DIFFUSE uptake at fx site and areas of bone
-week 4-12; BIPHASIC pattern with uptake localized more to bone ends
-week 12-2yrs; coalescence stage with focal uptake at fx site only
list the 3 types of vascular (hypertrophic) non unions and describe them
-elephant foot (heavy callus formation)
-horse foot (mildy hypertrophic with poor callus formation)
-oligotrophic (no hypertrophy or callus formation)
what causes a elephant foot to form
-unstable fixation and premature WB
what causes a horses foot to form
-moderately unstable fixation
what causes a oligotrophic non union
-results from displacement of fracture or fixation w/o direct apposition of fragements
what size gap can be healed with electrical stimulation
-can be used as long as the gap isnt more then 1/2 the diameter of the bone involved
-or less then 1 cm
how long does bone healing with electric stim take
3-6 months
why does anemia delay wound healing
-hemoglobin less then 10gm/dl with a hematocrit less hten 33% is considered inadequate tissue oxygen supply for proper healing
what is accuzyme?
papain-urea debriding agent
-only digests non-viable tissue
-pt may complain of buring sensation
List the 4 goals of AO (some german word for internal fixation)
1. anatomic reduction
2. preservation of blood supply
3. stable internal fixation
4. early active mobilization
what is the neutral axis of bone
-when bone is loaded, a compression side and a tension side develops; the axis w/o tension or compression is the neutral axis
is a plate placed on the tension or compression side of a bone and why
-plates can withstand tension, but not bending
-so place the plate on the tension side
what is the pitch of a screw
the distance between threads
which has a tighter pitch; cancellous screw or cortical
-cortical, making it more suitable for cortical bone
define a lag screw
-screw whose threads dont engage hte near cortex or one that doesnt have "near" threads
list the sequence of cortical screw insertion
1. glide hole (overdrill)
2. thread the hole (underdrill)
3. countersink
4. measure depth
5. tap(make thread pattern) and insert screw
what type of bone are cancellous screws meant for
-designed for soft metaphyseal and epiphyseal bone
3 conditions must exist for a screw to function as a lag (create compression across two sites)
1. the near cortex must have a glide hole
2. the far surface must be threaded
3. when tighthened, the screw head must contact the near surface of the cortex to comrpess the fragments
what is a trephine tip
self cutting tip
how is a cannulated screw used
-designed to minimize complications assoc. with screw insertion
-k wire is used to achieve reduction and intr-op xray is taken to confirm placement
-k wire then serves as a guide
how long after screw removal have fx across the screw been documented
-11 months after removal
-so pts should be in a cast for 3-4 weeks after removal
name 3 ways that plates can function
-interfragmentary compression
-plate can perform more then 1 fxn at a time
these plates can be T, L, spoon or cloverleaf shaped
-butress plates
what do butress plates do
-applied to a fracture site to prevent shift of the fragments under load
-low contact dynamic compression plate
-minimizes the disruption of the blood supply under the plate
Herbert Bone screw
-headless screw allows for insertion of the screw through articular cartilage
-used for osteochondral fragments, met osteotomies, akin osteotomy
Reese arthrodesis screw
-screw with clockwise threads proximally and counter clockwise thereads distally and smooth portion in the middle
-designed to create greater compression across arthrodesis site
complications of k wires and steinman pins
-skin protrusion as a site of pin tract infection
-loosening causing necrosis
-migration and motion (less with threaded wires)
complication of staples in bone
-cortical shattering
-distraction of fracture ends
-fx displacement on insertion of staple
if you are suturing in an infected wound, which type of suture should you use
swaged needle
-this is the most common needle type
-suture is directly attached to the needle (eyeless)
Ethilon, Surgilon, Ethibond, Dacron, Prolene, Surgilene
synthetic non absorbable
Dexon, Vicryl, PDS, Maxon and Monocryl
Synthetic absorbable