Chapter 12- Orthopaedic Medical Management Flashcards
Recommended analgesics for acute pain management
- morphine 10 mg IMI 6 hourly if required x 5 Doses only or morphine 1-2 mg IVI 4-6 hourly: titrated by nursing staff x 2 days
- indomethacin or diclofenac suppository 50- 100 mg BD X 5 days
- doxyphene 65- 130 mg 6 hourly X1 week
- tramadol/ Tramacet
- paracetamol administered parenterally or panado/ codeine combinations given orally. 2 tabs 6 hrly x 1 week
- ung meth sal
- local anaesthetics e.g. Macaine
Recommended analgesics for chronic pain management
- Panado/codeine combination
- Doxyphene
- amitryptiline
- ung meth sal
Red flags or danger signs when prescribing chronic analgesia
- patients who return frequently for repeat prescriptions
- patients who see many different doctors on frequent basis
- patients who require analgesic treatment beyond what you would expect to be the norm
When should one use anti- inflammatories
Primarily for control of an inflammatory process such as the inflammatory arthropathies. Do not use for pain of mechanical cause
Commonly used inflammatory agents
- NSAIDs: oral - diclofenac, indomethacin, ibuprofen. Local - traumeel gel, NSAID gel
- COX2 inhibitors: Celebrex
- steroids: non systemic- depomedrol, Celestone. Systemic- dexamethasone
Examples of joint rejuvenators (promote cartilage repair)
- ultra high molecular weight hyaluronic acid injected into joint
- joint nutrients such as glucosamine
Example of a counter irritant
Ung meth sal
Most common acute infections seem in ortho
Spontaneous or haematogenous septic arthritis and osteomyelitis
How to determine the site of acute infection
Through clinical examination. If in doubt- a bone scan is necessary
how to manage an acute infection
- Surgical drainage and debridement is the mainstay of resolution of established infection
- Obtain pus/ blood specimen for culture and microscopy before starting antibiotics
- Start the appropriate antibiotic: empiric –> specific
- Monitor response to treatment. Other sites of infection ? systemic problems? Appropriate antibiotics? bone at risk for fracture?
Treatment of pyogenic longstanding infection
- The presence of dead tissue, sequestrae, foreign bodies and biofilm (glycocalyx) formation demands surgical debridement as essential for resolution
- Antibiotic treatment must be based on identification, culture and antibiotic sensitivity of the organisms
- Surgery for infection in presence of implanted material requires removal of the foreign body. In fractures bone must unite before removal is contemplated. For joint replacements - exchange procedures are carried out with antibiotic protocols
Common pyogenic infections in ortho
Staph aureus Staph epidermitis E coli Strep viridans Pseudomonas Gonococcus H influenzae (neonate)
Common granulomatous infections in ortho
TB
Fungi
Common infestations
Hydatid
Antibiotic used for adult septic arthritis and osteomyelitis
- Cloxacillin. Fucidic acid may be added in compromised host or if poor response to cloxacillin treatment.
- If gonococcal: ciprofloxacillin and ceftaxime; if sensitive use Penicllin IMI
