DOCSLIB.ORG

Fellowship Revision Notes Dec 2014

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Fellowship Revision Notes Dec 2014 Fellowship Revision Notes Dec 2014 Page Acid-Base 2 Electrolytes 5 Cardiology 10 Dental, ENT, Ophthalmology 25 Dermatology 33 Rheumatology, Immunology 36 Endocrinology 41 Haematology and Oncology 47 Environmental 54 Gastrointestinal 65 Infectious Diseases 70 Management 76 Disaster and Retrieval 82 Neurology/Neurosurgery 88 O & G 97 Orthopaedics 107 Paediatrics 117 Psychiatry 130 Radiology 133 Renal 137 Urology 139 Respiratory 142 Resuscitation 151 Anaesthetics 157 Surgery 169 Toxicology 173 Trauma 197 Spinal 211 'All care, no responsibility' Feedback and corrections greatly appreciated Dr Laura Joyce, Advanced Trainee, Christchurch Hospital [email protected] shakEM by www.shakEM.co.nz is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. www.shakEM.co.nz 1 Acid-Base Summary HCO3 = 24 PCO2 = 40 BE = -3 to +3 Metabolic Acidosis Exp pCO2 =(1.5 x HCO3) + 8 Alkalosis Exp pCO2 = (0.7 x HCO3) +20 Observed > expected = concurrent respiratory acidosis Observed < expected = concurrent respiratory alkalosis Respiratory Acidosis Acute: 1 for 10: HCO3 = (pCO2 - 40)/10 x 1 Chronic: 4 for 10: HCO3 = (pCO2 - 40)/10 x 4 Alkalosis Acute: 2 for 10: HCO3 = (pCO2 - 40)/10 x 2 Chronic: 5 for 10: HCO3 = (pCO2 - 40)/10 x 5 Observed > expected = concurrent metabolic alkalosis Observed < expected = concurrent metabolic acidosis Anion Gap AG = Na + K - HCO3 Normal = 12 Low albumin falsely elevates AG - for every drop by 10 in albumin, drop AG by 3 Incr AGMA + met alkalosis + resp alkalosis = sepsis/salicylates Major disturbance always in same direction as pH Delta Ratio AG - 12 24 - HCO3 <0.4 hyperchloraemic NAGMA 0.4 - 0.8 NAGMA + AGMA 0.8 - 2 AGMA > 2 AGMA + metabolic alkalosis or chronic respiratory acidosis A-a gradient PAO2 = (FiO2 x 713) - (PaCO2 x 1.25) A-a gradient = pAO2 – paO2 Normal A-a gradient = < (age/4) + 4 Hypoxic + Raised A-a gradient – V/Q mismatch, shunt, diffusion block (fibrosis) Hypoxic + Normal A-a gradient - hypoventilation or low FiO2 (eg altitude) Osmolar gap Calculated serum osm = (2 X Na) + Ur + Glu + ETOH Osmolar gap = measured - calculated Normal osmolality = 270-290 Normal osmolar gap = -4 to +10 Raised osmolar gap: Alcohols - ethanol, methanol, EG Ketones - DKA, AKA, acetone Sugars - mannitol Lactate Proteins, lipids, excessively high ions (Mg, Ca, phos) U:C ratio U:C >100 - pre-renal failure www.shakEM.co.nz 2 Corrected Na Corrected Na = Na + Glucose – 5 3 Corrected K+ 0.1 decr in pH - 0.5 incr in K Lactic acidosis Type A Decr O2 delivery: shock, hypoxia, severe anaemia, CO poisoning Incr O2 demand: seizure, pyrexia, exercise, shivering Type B1 Systemic disorders: leukaemia, lymphoma, thiamine def, pancreatitis, short bowel Decr metabolism: hepatic failure, renal failure, hypothermia, DM, sepsis Type B2 Drugs/toxins: EtOH, toxic alcohol, Fe, salicylates, isoniazid, cyanide, CO, metformin Type B3 Inborn errors of metabolism AGMA Ketones DKA, AKA, starvation Lactate Type 1 (shock), Type 2 (metabolic) Renal failure Toxins Alcohols, salicylates, iron, cyanide, valproate, metformin, paracetamol NAGMA Chloride gain Normal saline Bicarb loss GI: diarrhoea, fistulas GU: RTA, Addisons, acetazolamide Cl retained when HCO3 lost to maintain electroneutrality Most common causes - EDA: Extra Cl - high K, urinary Na <10 Diarrhoea - low K, urinary Na <10 Adrenal insufficiency - high K, low Na, urinary Na >10 Low AG Low albumin High unmeasured cations (Ca, Mg, Li) Falsely elevated Cl (bromide, iodide) Nitrites Myeloma Metabolic Alkalosis Most common causes: vomiting, diuretics, incr aldosterone Chloride loss (saline responsive, Urine Cl <10) kidney reabsorbs HCO3 > Cl to maintain electroneutrality aka contraction alkalosis (fluid loss - decr renal perfusion - incr aldosterone - loss H/reabsorp HCO3) GI: vomiting, NG suction GU: diuretics Skin loss: burns Potassium loss (saline resistant), Urine Cl >10, often hypertensive) Syndromes: Cushings, Conns, Bartters Eating disorders Excess liquorice Excess base (saline resistant, Urine Cl >10, normotensive) Antacids, milk-alkali, bicarb, citrate (dialysis, transfusion) Respiratory Acidosis 1. Decreased respiratory drive - decr RR CNS CVA, tumour, encephalitis, haemorrhage, spinal cord lesion above C4 Drugs Narcotics and sedatives, ETOH www.shakEM.co.nz 3 2. Decreased chest wall movement - decr TV Neurological NM disorders, Guillain-Barre, Myasthenia gravis, demyelinating, tetanus, spinal trauma Toxicity Muscle relaxants, Organophosphates, fentanyl, spider+snake venom Respiratory Trauma, surgery, chest wall deformity, tension pneumo, pleural effusion, airway obstruction Muscular Electrolyte abnormality, myopathy, muscular dystrophy Equipment Increased dead space, improper connection 3. Obstructive pulmonary disease - incr dead space COPD, asthma, pneumonia, very severe croup, angioedema, severe pulm oedema, inhaled FB, aspiration Respiratory Alkalosis Full compensation in pregnancy and at altitude 1. Stimulated respiratory drive CNS CVA, ICH, psychogenic, cerebral oedema, hepatic encephalopathy Hyper-metabolic Thyrotoxicosis, Pregnancy, early sepsis, DT, anxiety, pain, DKA and aspirin OD Environmental Hyperthermia, altitude related, exercise Drugs Aspirin OD, ammonia, progesterone, theophylline, CO, stimulants Iatrogenic Mechanical ventilation 2. Hypoxemia induced Pneumonia, PE, asthma, Congenital heart disease, Chronic altitude comp, early altitude, pulm oedema 3. Compensation for metabolic acidosis Use of Bicarbonate 1. Hydrofluoric acid toxicity 2. Correction of severe metabolic acidosis 3. Prolonged cardiac arrest (evidence unclear) 4. Cardiotoxicity secondary to fast Na channel blockade 5. Urinary alkalinisation in OD - enhanced elimination 6. Prevention of drug redistribution to CNS – incr unionized amount of drug - Salicylates 7. Severe hyperK 8. RTA www.shakEM.co.nz 4 Electrolytes Summary Hyponatraemia Mild >125 Mild GI Sx (anorexia, N+V) Moderate 120-124 Lethargy, confusion, muscle weakness Severe <120 Decr LOC, seizures; brainstem herniation, cerebral oedema, osmotic demyelination 1. Hypertonic: Osm >295 Glucose, mannitol 2. Isotonic: Osm 275-295 aka pseudohyponatraemia: incr lipids, incr protein (myeloma, Waldenstroms) 3. Hypotonic: Osm <275 Due to: solute depletion or solute dilution a. Hypovolaemic (most common): Loss of Na > H20 Renal (urine Na >20) Diuretics, osmotic diuresis Addisons Na losing nephropathy (RTA, CRF) Extrarenal (urine Na <20) Upper GI: vomiting Middle GI: pancreatitis, bowel obstruction Lower GI: diarrhoea Others: sweat, bleeding, burns Management: give N saline; correct at <0.5mmol/hr or <12mmol/day; aim to get Na >125 b. Euvolaemic: SIADH Hypothyroid Water intoxication: psychogenic, iatrogenic (TURP syndrome) Drugs: SSRI/TCA/MAOI, ecstasy, oxytocin, carbamazepine, NSAIDs, omeprazole Test urine osmolality: <100mosm/L = primary polydipsia; >100mosm/L = SIADH or endocrine Management: fluid restrict to 500-1500ml/day; consider ADH antagonist if SIADH c. Hypervolaemic: Incr H20 >> Na ARF CHF, cirrhosis, nephrotic syndrome Management: fluid and salt restrict; diuresis (loop); dialysis Hypertonic saline Indications: coma, seizure, new onset profound decr LOC; not indicated if asymp Give 25-100ml/hr (1-2ml/kg/hr) 3% saline via CVL Can give more rapidly (500ml or 4-6ml/kg bolus over 10mins) if seizing Endpoint: Sx resolved/Na incr by 8-20mmol/L/Na >125 Aim for correction of 1mmol/L/hr (max 10-14mmol/L/day) SE: central pontine myelinosis (osmotic demyelination) if too rapid correction of chronic (>48hr) SIADH Hypotonic (<275) hyponatraemia (<130) Inappropriately high urine osmolality (>100) Elevated urine Na >20 Clinically euvolaemic Normal cardiac, renal, adrenal, thyroid, liver function Correctable with water restriction www.shakEM.co.nz 5 Causes: Malignancy (ectopic ADH) - lung (small cell, mesothelioma), GI, GU, lymphoma, sarcoma, thymoma Pulmonary - pneumonia, COPD, lung abscess, TB CNS - infection, abscess, AIDs, trauma, stroke Drugs - cytotoxics, antidepressants, antipsychotics, desmopressin, oxytocin, vasopressin Hypernatraemia (Na >150) 1. Iatrogenic, incapacitated NaHCO3, hypertonic saline Formula (infants), neglect (elderly) 2. Pure water loss (H20 > Na) - hypovolaemic Renal = osmotic diuresis (glucose), diuretics Extra-renal = diarrhoea, blood loss, third spacing Rx: Normal saline resus then 1/2 normal saline Water deficit (L) = 1L per 3-5 incr Na = (0.6 x kg) x ((Na-140)/140) Give deficit + maintenance (1500ml/day in adults), with 50% over 24hrs, 50% over 48hrs Correct for ongoing losses Too rapid correction - cerebral oedema; correct at <0.5mmol/L/hr or 10-15mmol/L/day 3. Aldosterone excess - hypervolaemic Primary: Conns, Cushings Secondary: CCF, cirrhosis, nephrotic syndrome, dehydration Rx: frusemide + free water. Dialysis if renal failure 4. Diabetes insipidus - euvolaemic Rx: same as euvolaemic without fluid bolus. ADH or DDAVP Symptoms occur with Na >158 Osm 350 – 375 Restlessness, irritability, thirst, anorexia, N+V Osm 375 – 400 Tremor, ataxia Osm 400 – 430 Hyperreflexia, twitching, spasticity Osm >430 Seizures, death; subcortical and SAH Na 150 – suggests dehydration Na 170-190 – suggests DI Na >190 – suggests incr Na intake Children: if mod: paedialyte no more than 15ml/kg/hr use 0.45% saline + 2.5% dex and replace over 48hrs if severe: use 0.45% saline + 2.5% dex and replace over 72-96hrs Diabetes Insipidus Inability to concentrate urine - large amounts of severely diluted urine Failure of: - production of ADH (central DI: neoplasm, pituitary surgery, trauma, idiopathic) - response to ADH (nephrogenic DI:
Load more

Recommended publications
  • Clinical Excellence Series Volume V an Evidence-Based Approach to Traumatic Emergencies
    Clinical Excellence Series n Volume V An Evidence-Based Approach To Traumatic Emergencies Inside Neck Trauma: Don’t Put Your Neck On The Line Orthopedic Sports Injuries: Off The Sidelines And Into The Emergency Department Blunt Abdominal Trauma: Priorities, Procedures, And Pragmatic Thinking Wrist Injuries: Emergency Imaging And Management Brought to you exclusively by the publisher of: An Evidence-Based Approach To Traumatic Emergencies CEO: Robert Williford President & Publisher: Stephanie Ivy Associate Editor & CME Director: Jennifer Pai • Associate Editor: Dorothy Whisenhunt Director of Member Services: Liz Alvarez • Marketing & Customer Service Coordinator: Robin Williford Direct all questions to EB Medicine: 1-800-249-5770 • Fax: 1-770-500-1316 • Non-U.S. subscribers, call: 1-678-366-7933 EB Medicine • 5550 Triangle Pkwy Ste 150 • Norcross, GA 30092 E-mail: [email protected] • Web Site: www.ebmedicine.net The Emergency Medicine Practice Clinical Excellence Series, Volume V: An Evidence-Based Approach To Traumatic Emergencies is published by EB Practice, LLC, 5550 Triangle Pkwy Ste 150, Norcross, GA 30092. Opinions expressed are not necessarily those of this publication. Mention of products or services does not constitute endorsement. This publication is intended as a general guide and is intended to supplement, rather than substitute, professional judgment. It covers a highly technical and complex subject and should not be used for making specific medical decisions. The materials contained herein are not intended to establish policy, procedure, or standard of care. Emergency Medicine Practice, The Emergency Medicine Practice Clinical Excel- lence Series, and An Evidence-Based Approach to Traumatic Emergencies are trademarks of EB Practice, LLC.
    [Show full text]
  • Knee Injuries
    6/11/2019 Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e Chapter 274: Knee Injuries Rachel R. Bengtzen; Jerey N. Glaspy; Mark T. Steele ANATOMY The knee consists of two joints, the tibiofemoral joint and the patellofemoral joint. Within the tibiofemoral joint, the distal femur (comprised of the medial and lateral femoral condyles) articulates with the proximal tibia (comprised of the medial and lateral tibial condyles) (Figure 274-1). The medial and lateral menisci are situated between the articular surfaces, and the menisci provide cushion, lubrication, and resistance to articular wear (Figure 274-2). In the patellofemoral joint, the patella articulates with the distal femur along the anterior depression called the patellofemoral groove during flexion and extension of the knee. The patella is stabilized by the patellar tendon and medial retinaculum. FIGURE 274-1. The supracondylar and condylar areas of the femur, and the medial and subcondylar areas of the tibia. 1/29 6/11/2019 FIGURE 274-2. Ligaments of the right knee joint. The articular capsule and the patella have been removed. 2/29 6/11/2019 There are four ligaments in the knee: the anterior cruciate ligament, the posterior cruciate ligament, and the medial and lateral collateral ligaments (Figure 274-2). These ligaments provide strength and stability to the knee. The posterior aspect of the knee, the popliteal fossa, contains the popliteal artery and vein, the common peroneal nerve, and the tibial nerve (Figure 274-3). FIGURE 274-3. Posterior knee: popliteal fossa anatomy. 3/29 6/11/2019 CLINICAL FEATURES Determine the mechanism of knee injury and review all prior orthopedic injuries or surgical procedures.
    [Show full text]
  • Imaging Review: Modalities and Practice Guidelines Bryan M
    Imaging Review: Modalities and Practice Guidelines Bryan M. Bond, BSc, BS, DC, MS, PhD April 7th, 2017 Wichita, Kansas 1 Objectives……. 1. Recognize how the study of human imaging can make the clinician’s evaluation and management of the patient more comprehensive. 2. Discuss and describe the clinical impact of imaging technologies used in musculoskeletal conditions. 3. Describe, compare and contrast the major roles of conventional radiography, magnetic resonance imaging, computed tomography, ultrasound, and bone scintigraphy in clinical decision making. 2 Objectives……. 4. Acquire an ability to transform visually three-dimensional anatomy into two-dimensional radiographic anatomy to enable identification of normal and abnormal anatomical structures on radiographs. 5. Describe and discuss the evidence-informed clinical practice guidelines to promote appropriate imaging or treatment decisions. 3 Goals……… • NOT to teach you A through Z, but….. – Review some information – Add some new knowledge – Stimulate further thinking……………… 4 General Outline • Integration of Imaging into • Diagnostic Imaging Clinical PT Practice Prediction Rules (CPRs) • Special Imaging Techniques • Case-Based Learning • General Principles and Evaluation • Summary of Tissue 5 Integration of Imaging into Physical Therapy Practice 6 Changing Perspectives on Diagnostic Imaging in PT Education 7 The Traditional Model • PT gradually evolved into profession with specialized areas of practice, including primary care, requiring considerable expertise in MSK evaluation – In response,
    [Show full text]
  • DCMC Radiology Newsletter 10:15
    “docendo discimus” VOL 2 NO 10 OCTOBER 2015 DCMC Emergency Department Radiology Case of the Month These cases have been removed of identifying information and are intended for peer review and educational purposes only. Welcome to the DCMC Emergency Department Radiology case of the month! In conjunction with our pediatric radiology specialists from ARA we hope you enjoy these monthly radiological highlights from the case files of the Emergency Department at DCMC. These cases are meant to highlight important chief complaints, cases, and radiology findings that PEM Fellow Conference Schedule October 2015 we all encounter every day. 6th - Faculty Development: Simulation....................................................Dr Floyed If you enjoy these reviews we invite you check out Faculty Development: Research..................................................Dr Wilkinson Pediatric Emergency Medicine Fellowship Radiology 7th - 8:15-10:15 Sim: Cardiology.......................Drs Wyrick and Ryan/Sim Faculty Rounds, which are currently offered quarterly and are held 11:15-12:15 TBD with the outstanding support of the pediatric radiology 14th - 9:15-10:15 US: Renal/Abdominal Pathology..................................Dr Boeck specialists at Austin Radiologic Association. 11:15-12:15 Grand Rounds If you have any questions or feedback regarding the 16th - PEM Fellowship Applicant Interview Day Case of the Month format, feel free to email Robert Vezzetti, MD at 20th - Living Well in PEM.........................................................PEM
    [Show full text]
  • Orthopaedics Summary Dec 2014
    Orthopaedics Summary Dec 2014 General management Haemorrhage control (1.2-1.5L in femur; 0.5-1L in tibia; 500ml in humerus) Decontamination: if open; irrigation - early surgical debridement Analgesia , ADT Antibiotics: fluclox 2g QID; significant soiling/>10cm wound/loss of bone coverage: gent + augmentin Elevation Reduction + Immobilisation Urgent OT if: amputation for life saving; uncontrollable haemorrhage; open #; contaminated; ischaemia >6-8hrs Increased risk # infection Contaminated; STI; debridement delay 8hrs; Abx delay 3hrs Staph aureus, strep pyogenes; C perfringens Fracture Complications Acute Soft tissue: compartment syndrome, skin necrosis, rhabdo Nerve: neuropraxia or transection Vascular: contusion or traction, distal ischaemia, haemorrhage Bone infection, other bone injuries Visceral complications Fat Embolism Iatrogenic: Complications of anaesthesia, manipulation, hospitalisation, medications Delayed Union: Non, Slow, Delayed, Malunion Traumatic epiphyseal arrest Joint Stiffness, early OA AVN Volkmann’s ischaemic contracture CRPS Myositis ossificans Osteomyelitis Social - Loss of function, mobility, work Complex Regional Pain Syndrome Group 1 : “Sudeck’s atrophy, reflex sympathetic dystrophy” Group 2 : Injury to major peripheral nerve eg gunshot wound/amputation affecting sciatic n. Ottawa Ankle Rules Pain in malleolar area + 1: tender posterior edge or tip lateral malleolus 2: tender posterior edge or tip medial malleolus 3: unable to WB 4 steps immediately and in ED Ankle # Classification Potts: Uni/bi/trimalleolar;
    [Show full text]
  • Clinical Prediction Rules: Diagnosis
    CLINICAL PREDICTION RULES: DIAGNOSIS Evidence-Based Clinical Prediction Rules Used in Physical Therapy Practice to Predict the Probability of a Specific Disease or Outcome Created by Breanna Spain | @pt_studybuddy 1 MSK CLINICAL PREDICTION RULES/DIAGNOSTIC CLUSTERS PATHOLOGY OR NEED REGION JOINT CLUSTER FOR RADIOGRAPHS ● (+) Apprehension Test Anterior Instability ● (+) Relocation Test ● (+) Anterior Drawer Test ● Age > 65 Rotator Cuff Tear ● Night pain ● Weakness in external rotation Shoulder ● Age > 60 Rotator Cuff Tear ● (+) Drop Arm Test Upper (Full-Thickness) ● (+) Infraspinatus MMT Extremity ● (+) Painful Arc ● (+) Hawkins-Kennedy Test Subacromial Impingement ● (+) Infraspinatus MMT ● (+) Painful Arc ● Age > 45 ● Shaking hands to relieve symptoms Wrist Carpal Tunnel Syndrome ● Wrist-ratio index > 0.67 ● Decreased sensation in thumb ● Symptom Severity Scale > 1.9 HIGH RISK FACTORS: ● Age > 65 ● Dangerous MOI ● Paresthesia in extremities LOW RISK FACTORS: Canadian Cervical ● Simple rear-end MVA Spine Rules ● Normal sitting posture in ER (need for radiographs) ● Ambulatory since injury ● Delayed onset of neck pain and absence of midline tenderness **If (1) high risk factor or (2) low risk factors AND the inability to actively rotate the neck > 45° bilaterally are present, radiographs are indicated Spine Cervical ● Age < 55 ● Single Cervical Closed Fracture ● Trauma ● Acute ● ER visit ● Age > 45 ● Gait deviation Cervical Myelopathy ● (+) Hoffman’s Test ● (+) Inverted Supinator Test ● (+) Babinski Test ● (+) Distraction Test Cervical
    [Show full text]
  • Conflict of Interest Learner Outcome Objectives How We Make Radiographs
    10/14/2016 Objectives Five shades of gray (Part Two); • Identify the appropriate imaging modality Advanced Radiographic to evaluate common musculoskeletal interpretation and treatment complaints, what to order when. for the APN • Describe the basic principles used in ordering and interpreting musculoskeletal imaging studies in musculoskeletal Christina M Kurkowski, Nurse Practitioner complaints. Conflict of Interest Nov 8 , 1895: The Birth of Radiology I hereby certify that, to the best of my knowledge, no aspect of my current • 11/8/95 Wilhelm Conrad Röntgen personal or professional situation might produces “X - rays” reasonably be expected to affect • 12/28/95 Röntgen presents: “On a significantly my views on the subject on New Kind of Rays” which I am presenting. • 2/11/96 Jones publishes: “The Discovery of a Bullet Lost in the Wrist 1901:Röntgen wins by Means of the Roentgen Rays” 1st Nobel prize in physics Learner Outcome How we make radiographs As a result of this learning activity, the participant will gain knowledge in the area of radiographic interpretation and interventions and implement appropriate changes in practice 1 10/14/2016 X - rays as Diagnostic Tool What is the best imaging test? Can See Can’t See • Plain film radiographs Bones Inside skull • MRI • Fractures • Can’t see the brain • CT Joint Width, surfaces Inside joints • US • Arthritis • Can’t see tears • Bone Scan – Osteophytes – Ligaments, • MR Arthrography tendons – Erosions • CT Arthrography – Menisci, cartilage Tips for requesting films • Consulting radiologist needs info to confirm: – Correct study was requested – Correct patient What is the cause of – Meds, allergies, status caveats musculoskeletal pain? – Cost/benefit ratio favors the patient: • Risk, dose, pain, complication, sometimes $$ • Will it alter management? If not – NO! Clinical Evaluation • DNR, religious beliefs, life expectancy….
    [Show full text]
  • ABCDE Evaluation, 155 Abscesses, 152 Foot, 152 Spinal Epidural
    Cambridge University Press 978-1-107-69661-7 - Orthopedic Emergencies: Expert Management for the Emergency Physician Michael C. Bond, Andrew D. Perron and Michael K. Abraham Index More information Index ABCDE evaluation, 155 anterior posterior pelvic proximal humerus, 60–62 abscesses, 152 fracture, 88, 89, 90 arm slings, 268 foot, 152 anterior radial head dislocation, arterial injury, 69 spinal epidural, 159–160, 186 234, 235 brachial, 69 acetabular fractures, 89–93, anterior shoulder dislocations, knee, 110, 113 99, 223 44, 236, 237 arthritis, 150, 189, 200, See also Achilles tendon injuries, anterior sternoclavicular septic arthritis 142–143, 258, 269 dislocations, 55, 56, arthrocentesis, 178, 179, 180, acromioclavicular injuries, 213, 215 200–203 57–60 anterior superior iliac spine, arthroplasty, 94, 225 acromioclavicular joint, 213 82, 83 arthroscopy, 114, 115, 117, acute osteomyelitis, 183, 184 anteromedial knee dislocation, 120, 137 airway management, 155 112 aseptic technique, 203 Allis technique, 223, 225 anteroposterior radiography. ASIA impairment scale Allman Type fractures, 54 See AP view (AIS), 156 amoxicillin–clavulanate, 182 antibiotics, 18 avascular necrosis (AVN), 6 ampicillin–sulbactam, 181 amputations, 43 femoral neck fractures, 94, 100 amputation, 114 clenched fist injuries, 182 hip dislocation, 225 below knee, 151, 153 foot infections, 145, 152 hip fractures, 93, 223 hand and wrist, 38, 42–43 infectious tenosynovitis, 181 lunate, 9 anesthesia. See local anesthetics, metacarpal head fracture, proximal humerus fracture,
    [Show full text]
  • 2015 Abstracts
    MID-AMERICA ORTHOPAEDIC ASSOCIATION 33rd Annual Meeting April 22-26, 2015 The Westin Hilton Head Island Resort Hilton Head Island, SC Podium and Poster Abstracts NOTE: Disclosure information is listed at the end of this document. *Denotes presenter MAOA FIRST PLENARY SESSION April 23, 2015 Irrigation and Debridement Prior to a Two-Stage Revision TKA Does Not Increase Risk of Failure Abstract ID: Paper 001 Olubusola Brimmo, M.D. Nicholas Schlitz, Ph.D. Aiswarya Pillai Chandran, M.S. Siran Koroukian, Ph.D. *Alison K. Klika, M.S. Carlos A. Higuera, M.D. Wael K. Barsoum, M.D. Cleveland, OH INTRODUCTION: Studies have shown an increased rate of failure of two-stage revision total knee arthroplasty (rTKA) after a failed irrigation and debridement (I&D) for prosthetic joint infections (PJI) of the knee. The objective of this study was to compare failure rates of patients following two-stage rTKA with and without a previous I&D. METHODS: The 2005-2011 State Inpatient Database (SID) from 2 states (CA and NY) was used to identify patients who underwent two-stage rTKA for PJI between 2007-2009 (using ICD- 9-CM procedure and diagnosis codes). The main exposure was I&D. A two-year look back period was used to detect those patients who had an I&D prior to two-stage rTKA, and the outcomes of the two groups (with and without prior I&D) were compared. The primary outcome was failure of the two-stage rTKA (i.e., defined as the need for subsequent surgery due to infection, including ICD-9 diagnosis code 996.66).
    [Show full text]
  • Emergencymedicinepracti
    EMERGENCY MEDICINE PRACTICE EMPRACTICE.NET AN EVIDENCE-BASED APPROACH TO EMERGENCY MEDICINE April 2003 Orthopedic Sports Injuries: Volume 5, Number 4 Off The Sidelines And Into Authors Lisa Freeman, MD, FACEP Assistant Residency Director, Department of Emergency The Emergency Department Medicine, University of Texas Medical School at Houston, Houston, TX. 8:50 p.m., Friday night: Paramedics radio ahead—they are bringing in a local high Adam Corley, MD school football player who was tackled during a game. He can’t feel or move anything Department of Emergency Medicine, University of Texas Medical School at Houston, Houston, TX. below his legs. The news media are already at the hospital asking questions. The paramedics want to know whether they should start steroids. The on-call neurosurgeon Peer Reviewers is not answering his pages. Mohamud Daya, MD, MS, FACEP, FACMT, DTM&H Associate Professor of Emergency Medicine, Oregon PORTS injuries present unique challenges to the emergency physician. Health & Science University, Portland, OR. From the little-leaguer to the cardiac rehabilitation patient, millions of S David Della-Giustina, MD, FACEP Americans participate in sports or fitness activities. While an athletic injury LTC, U.S. Army; Emergency Medicine Consultant to the rarely requires a life- or limb-saving intervention in the ED, the personal impact Surgeon General of the Army; Chairman and Program on the player can be monumental. Emergency physicians must be expert in the Director, Madigan Army Medical Center—University of diagnosis and initial treatment of sports-related injuries. Washington Emergency Medicine Residency; Clinical Assistant Professor of Medicine, University of Each year in the United States, an estimated 150 million adults participate Washington; Adjunct Assistant Professor of Military and in some type of non-work-related physical activity, and approximately 30 Emergency Medicine, Uniformed Services University, million children and adolescents participate in organized sports.1 From July Tacoma, WA.
    [Show full text]
  • ACC Treatment Profiles 2001
    ACC5157 Cover a/w.fh8 11/12/00 1:06 PM Page 1 Printed December2000 ISBN0-478-11756-6 579 ACC Treatment Profiles Treatment 2001 Treatment Profiles 2001 Composite ACC5157 Cover a/w.fh8 11/12/00 1:06 PM Page 2 IMPORTANT PLEASE READ BEFORE CONTINUING The information contained in these Treatment Profiles is Copyright to Accident Compensation Corporation (ACC). December 2000. All Rights Reserved. These Profiles are made available by ACC to the recipient on the basis that they will be kept and used only by the recipient, and not lent, sold or otherwise made available to any third party or reproduced in any way, without ACC’s prior written consent. By opening these Profiles the recipient is agreeing to this condition but, if not agreed to, these Profiles are to be promptly returned to ACC. Composite Treatment Profiles 2001 CONTENTS 1 Return to Work 2 Fractures/Dislocations – Plastering Guide 3 Burns 4 Gradual Onset 5 Sprains 6 Lacerations/Abrasions 7 Contusions/Crush Injuries 8 Miscellaneous Introduction KEY POINTS • Treatment Profiles 2001 are consensus-based (not evidence-based) guidelines and are NOT rigid protocols. They are intended as a resource for clinicians to help summarise current practice in management of common injuries • Read codes: recording of injury diagnosis as Read codes is essential. Record the lowest relevant level of Read code For multiple injuries record Read codes for each injury If you cannot find a Read code for the injury, use code Z (unspecified conditions) and provide an accurate written diagnosis • Incapacity Duration Guides contained in the Profiles should be used where possible for any “time off work” certification ACC is responsible for providing access to the most effective treatment, rehabilitation and support services to help claimants lead as normal a life as possible after an injury.
    [Show full text]
  • Fractures (Non-Complex): Assessment and Management Fractures: Diagnosis, Management and Follow-Up of Fractures
    National Clinical Guideline Centre 1 Final Fractures (non-complex): assessment and management Fractures: diagnosis, management and follow-up of fractures NICE Guideline NG38 Methods, evidence and recommendations February 2016 Final Commissioned by the National Institute for Health and Care Excellence Fractures: non complex Contents Disclaimer Healthcare professionals are expected to take NICE clinical guidelines fully into account when exercising their clinical judgement. However, the guidance does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and, where appropriate, their guardian or carer. Copyright National Clinical Guideline Centre, 2016 Funding National Institute for Health and Care Excellence National Clinical Guideline Centre, 2016 Fractures: non complex Contents Contents National Clinical Guideline Centre ................................................................................................ 1 Guideline Development Group full members ............................................................................... 11 Guideline Development Group expert members .......................................................................... 11 Project Executive Team members ................................................................................................. 11 NCGC technical team members .................................................................................................... 12 Peer reviewers
    [Show full text]