CEN Ortho

1 - 1 1/2 inches

• 12 inchest forward
• 6 inchest to side of body

• uninjured leg up first then injured leg with
• crutches

crutches down one step then injured leg then uninjured leg

reaches pt wrist when cane on floor, handgrips should be level with ulnar side of wrist

elbow slightly bent in hand opposite injured side

cane and injured leg should move together

cane is kept 4to 5 inches forward

L5 and some L4

detail of disc and nerve root, useful for finding tumors and spinal infections

- no lifting over 25 pounds until pain has resolved

- normal activities within 7 to 10 days

• ultrasound
• needle aspiration
• increased ESR if r/t autoimmune or inflammatory process

• cold therapy for first 48 hours
• RICE
• NSAIDS
• poss ABX

• lateral - tennis elbow
• medial - golfer's elbow

• sling/brace to rest tendon
• ice for first 48 hours
• compression - take off bid
• elevation
• NSAIDS

• urate or Ca crystals deposited into a joint ->
• arthritis

• 1. pain begins in one joint and moves to other
• 2. intolerable pain with clothes, mvmt, etc
• 3. swollen, red, tender joints
• 4. may have fever

• - may have increased WBC and ESR if acute
• - uric acid levels may be increased

definitive Dx is synovial fluid analysis

• 1. NSAIDS
• 2. steroids
• 3. colchicine may be given to young, healthy pt

• damage to joints
• kidney stones

compression neuropathy of the median nerve at the wrist

1. tinel sign:  tapping lightly over medial nerve causes sensation of tingling that indicates nerve irriation

2. phalen test - push the back of hands together X1 min  - tingling occurs

soft tissue swelling maybe, tingling, atrophy of surrounding muscles, red shiny skin above affected area

WBC 20,000-60,000 with normal glucose - inflammatory process

WBC >/= 100,000 with decreased glucose indicates infection

• 1. tx for swollen joint
• 2. immobilization of affected joint
• 3. prep for possible arthrocentesis

uncontrollable pain, sepsis, meniscus tear

inflammation of rib and sternal junction with pain and tenderness

• 1. repetitive minor trauma
• 2. chest surgery or trauma
• 3. Hx of IV substance abuse
• 4. recent URI

• chest pain
• worsening with inspiration, cough, movement
• - redness/warmth/tenderness

- atelectasis and/or pna

- incentive spirometry, deep breathing exercises

• 1. regular exercise recommended
• 2. calcium to preserve bone mass

• 1. band keratopathy
• 2. hyperthyroidism - exopthalmos
• 3. hypogonadism - decreased facial or axillary hair
• 4. osteogenesis imperfect - blue sclera

antiresorptive meds:  bisphosphonates

• closed = simple
• open = compound

ends of bone are not aligned

directly across bone

angled across bone

from a twisting motion

separation of bone fragment from the bone

bone broken into fragments

compression of bone with shortening

incomplete fractures in which one side of the bone may buckle upon itself without disrupting the other side

one bone forced against another

subluxation of the radial head - usually seen in children 2-3 years old - caused by pulling of arm

immobilize joints above and below fracture

• - splint in position found unless pulseless
•  - if pulseless - reposition and recheck pulse

don't use on wounds - can inhibit wound healing

• 1. uncontrolled pain
• 2. hemorrhage
• 3. shock
• 4. fat emboli
• 5. compartment syndrome`

rare -consider thoracic injuries

rare - associated with seizures and ethanol abuse

neurovascular compromise can occur - permanent loss of some function is common

extremity flexed and adducted with loss of ROM

• - deformity with wide abduction & external rotation of the extremity
• - affected leg will appear to be shorter than the affected leg
• - femoral head necrosis can occur - TRUE
• EMERGENCY

direct pressure, tourniquets are not recommended

minimization of movement of stump to prevent renewed hemorrhage

• - clean stump and amputated part with normal saline
• - apply moist sterile dressing and wrap in light ACE
• - splint and elevate stump

• - wrap in moist, sterile saline guaze dressing
• - place in plastic bag, seal bag, and place in ice water
• - label plastic bag with pt name, ID, and date
• - monitor bag and do not let part freeze

with cooling may be viable for up to 12 hours and digits may be viable for up to 24 hours

may not be visible - can continue for up to 48 hours

interstitial pressure exceeds capillary pressure, causing localized muscle and nerve ischemia

• - tissue necrosis
• - permanent functional impairment
• - renal failure
• - death

• - remove all external compression
• - do not elevate
• - no ice

• - long-bone & pelvic fractures
• - parenteral lipid infusion
• - recent steroids

• - s/s may take  12 to 72 hours after injury to occur
• - dyspnea, tachypnea, crackles, cough
• - palpitations, tachycardia, hypotension
• - possible syncope
• - fever 101.4-104
• - restlessness
• - petechial hemorrhages

decreases initially due to hyperventilation then increases as resp failure occurs

f/q mismatch

pulmonary infarction, cerebral infarction, myocardial infarction, dysrhythmias, acute respiratory distress syndrome

surgery, trauma, immunocompromise, IV substance abuse

needle aspiration or bone biopsy

• splinting and limiting activity initially
• up to 6 wks abx

platelets, clotting factors, and calcium

avoid sunlight to the area for 6 months - may cause pigment changes

• sterile  dressing applied to area 
• - petroleum jelly gauze, layered dressing, metal protector
• - gelfoam for bleeding
• for degloving:  realign tissue and cover with sterile dressing

• seal off:  increased risk for infection
• near joint can put joint at risk

soak the wound 2 or 3 times a day

wounds with packing should not be soaked

natural wood splinters or clothing

do not soak if FBO is wood - will cause wood to swell

entry and exit wounds have no bearing on the amnt of damage

document entry and exit wounds but do not differentiate

• rattlesnakes, copperheads, and cottonmouths
• (water moccasins)

pit b/t eye and nostril , cat-like pupils, and triangular head

• - deliver venom through 2 fangs retracted at
• rest

- copperheads milder venom that may not require antivenom

black, red, and yellow bands, black heads, slender bodies, round/black eyes

lack fang marks of pit  vipers - bite harder to detect

can cause respiratory paralysis r/t neurotoxic venom

• 1. may be painful - rattlesnake painful, coral snake not initially painful
• 2. NV
• 3. blurred vision
• 4. swelling/redness
• 5. petechiae, ecchymosis
• 6. neurologic changes
• 7. renal failure

local:  fang marks, edema, pain, petechiae, ecchymosis, loss of function of limb, necrosis

systemic:  NV, diaphoresis, syncope, metallic or rubbery taste in mouth, paralysis, visual distrubances, muscle twitching, hemorrhage, renal failure, and death

6 P's, measurement of extremity girth every 15 minutes

immobilize in neutral position at level of injury

• - below heart increases swelling
• - above heart allows venom to travel through body

4 hours

0.02 ml of 1:10ml dilution or 1:100 dilution if pt has suspected sensitivity to equine serum

• = ice/cooling - can increase necrosis and  toxicity of venom
• - tourniquets
• -incisions into the wound

• 1. compartment syndrome
• 2. skin infections
• 3. coagulopathy
• 4. anaphylaxis or anaphylactic shock
• 5. serum sickness - usualy 1-2 wks after treatment with antivenin

gently remove with a blunt angled, medium sized forcepts with steady, upward pulling motion

wash with antiseptic soap

pain - sharp pinprick followed by dull, numbing pain that progresses to severe pain in 15-60 minutes and increases in 12-48 hours

cramping, NV, ABD/back/thorax/groin pain

• dyspnea may occur
• tiny fang marks
• swelling
• fever
• tremors
• systemic anaphylactic reaction may occur within 30 minutes

- vague Hx