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Discriminative sensations, casting, dislocation Flashcards

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1
Q

How should you help the patient feel like they have privacy at the appt?

A
  • close nearby doors and draw curtains
  • wash hands each time you see a patient
  • drap patient with gown or sheet
  • describe what you are going to do to the patient before doing it
  • keep patient informed throughout exam
  • make instructions courteous and clear
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2
Q

When doing the discriminative sensation exam, should patient eyes be open or closed?

A

closed

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3
Q

Stereogenesis

A
  • Ability to ID an object by feeling it
  • Place a familiar object in hand and have patient tell you what it is
  • Normally a patient will tell you what it is in 5sec
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4
Q

How to add a sensitivity component to stereogenesis

A

have patient tell you if coin is head or tails

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5
Q

Astereogenesis

A

inability to recognize objects in hand

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6
Q

Graphesthesia

A
  • number identification
  • Used for patients with motor impairment, arthritis or conditions preventing them from manipulating an object in hand
  • With blunt end of pen, draw a number on patient palm and a normal person can ID it
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7
Q

Two point discrimination

A
  • Using two ends of open paper clip touch a finger pad in two places simultaneously
  • Alternate with one point
  • Determine the minimal distant at which a patient can discriminate 1 from 2
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8
Q

Normal response in two point discrimination

A

<5mm on finger pads

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9
Q

What increases the distance between two points in two point discrimination

A

lesion of sensory cortex

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10
Q

Point localization

A
  • Briefly touch a point on the patients skin
  • Ask patient to open eyes and point to area touched
  • Normally it can be done accurately
  • Useful on trunk and legs
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11
Q

Extinction

A
  • Simultaneously stimulate corresponding areas on both sides of the body
  • Ask where the patient feels your touch
  • Normally both are felt
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12
Q

If a patient has a lesion on the left side of sensory cortex, where will the stimulus on leg be extinguished

A

right side

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13
Q

A lesion in what area will effect discriminative sensations

A

sensory cortex

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14
Q

What is a shoulder dislocation

A

head of humerus is out of socket (glenoid cavity)

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15
Q

What is a subluxation

A

temporary and partial dislocation

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16
Q

Patient with shoulder dislocation will have?

A

poor ROM and lots of pain

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17
Q

arm is slightly abducted and externally rotated; humeral head may be felt anteriorly and the void seen posteriorly (sulcus signs)

A

Anterior dislocation

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18
Q

If anterior dislocation, is there injury to axillary nerve

A

NO

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19
Q

patient arm internal rotation and adducted; prominent humeral head seen and palpated posteriorly; patient guards the extremity

A

posterior dislocation

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20
Q

Treat shoulder dislocation

A
  • prompt reduction or glenohumeral joint
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21
Q

Increased risk of a patellar dislocation

A

Patellofemoral malalignment, abnormal patellar configuration and previous history of instability

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22
Q

Acute pain after direct contact or sudden change in direction, fell the knee giving way due to quad pain, rapid swelling, intense knee pain and difficulty with knee flexion, joint knee effusion

A

patellar dislocation

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23
Q

If there is significant tenderness medially near the medial retinaculum what do we think

A

tear

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24
Q

Apprehension sign

A

Knee placed at 30 degrees flexion and leteral pressure is applied. Medial instability results in apprehension by patients

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25
Treat patellar dislocation
If fracture noted with dislocation obtain orthopedic consultation
26
Where do we immobilize a joint
above and below the injury
27
How do we wrap the ace
distal to proximal to prevent trapping of blood distal to injury
28
What must we do before an after splinting
distal circulation, motor function and sensation
29
Pain with a splint or cast is what?
compartment syndrome
30
Do preformed splints provide same level of immobilization as custom
NO
31
What type of water do we use when splinting and casting
room-temperature
32
What happens when plaster put in water
gypsum recrystallizes and harden in an exothermic reaction
33
Complications of splinting
too loose: sores and abrasions | too tight: neuromuscular compromise/injury, contact dermatitis, pressure sores
34
Stockinette sizing
``` 1in= finger and thumb 2in= hands and young kinds 3in= upper extremity 4in= legs ```
35
When using Webril, how much do we overlap each layer
50%
36
Why do we use Webril
protect the skin from chaffing or blisters from hard splint material
37
What do we use for shoulder and humeral injuries
sling and swather
38
Sling without swather for
clavicle fractures
39
What does the sling and swathe do
Sling supports weight of arm and swather holds arm against chest to minimize shoulder motion
40
When do we give a cast
5-7 days after injury and swelling has resolved
41
TOC for nonoperative fractures
castign
42
How long do we keep a cast on? When do we change it?
4-6 weeks; 3 weeks
43
How much padding for casting
2 layers UE, 3-4 layers LE
44
Goal of molding cast
maintain alignment of fracture
45
What shape is best to maintain fracture alignment
elliptical
46
3 point molding
- 1st point over apex of fracture with force directed opposite direction of fracture to displace - two remaining points lie on opposite side of bone at either side of apex
47
DTR 4+
Very brisk, hyperactive with clonus
48
DTR 4+ common in
CNS lesions along the descending corticospinal tract
49
DTR 3+
Brisker than average; possibly but not necessarily indicative of disease
50
DTR 2+
Normal
51
DTR 1+
Somewhat diminished; low normal
52
DTR 0
no response
53
DTR 0 seen in
disease of spinal nerve roots, spinal nerves, plexuses or peripheral nerves
54
Assisted ventilation can
decrease ICP or correct hypercarbia and acidosis
55
Oxygenation needed in people with
severe lung disease of injury who are unable to maintain acceptable PaO2
56
Why do people need airway managed
- Overcoming or preventing airway obstruction - Prevention of aspiration - Administration of intratracheal drugs
57
Does a CXR confirm placement into trachea
NO
58
Key airway landmarks
- Thyroid lamina - Arch of cricoid cartilage - Median cricothyroid ligament
59
Miller versus McIntosh
Straight laryngoscope bade is Miller and curved is McIntosh
60
Who gets cuffed tube
adults and older kids
61
Best method to confirm placement of ET
see tube pass through cords
62
What is rapid sequence intubation
method of safely paralyzing and intubating a patient with a full stomach to prevent aspiration
63
When to use NG tube
gag is present
64
When to use oropharyngeal tube
gag absent
65
When house bag-valve apparatus
NG tube places
66
What hand laryngoscope held
Left
67
MC intubation
orotracheal
68
MC cause spinal trauma
MVC and falls
69
Most important thing to establish in patient with spinal injury
mental status normal
70
RA can lead to
subluxation problems C1/C2
71
X-rays obtained in potential spinal injury
cross table lateral and c-spine
72
Missed injuries in cross table lateral
injury at C1/C2
73
When assess c-spine films what are we looking at in soft tissue
Preverebral swelling, especially at C2-C3 (more than 5mm), and check the predental space, which should be <3mm in adults and <5mm in kids
74
CT is used to ID
vertebral fractures and handling
75
MRI used for
- Evaluation of injury of spinal cord itself or rupture of the intervertebral disc - Demonstrate areas of contusion and edemain the cord, as well as areas of compression
76
Important things to do with C-spine injuries
proper immobilization and caution handling
77
In a C-spine injury, you may not be able to maintain what? How to treat?
- tidal volume because intercostal muscles are nonfunctional | - monitor respiratoyr status
78
SCIWORA
- spinal cord injuries without radiograph abnormalities | - Children more susceptible because greater elasticity of cervical structures
79
What do we assume if pain perception is altered by alcohol, drugs, head injury, shock or other causes?
injury is present
80
AMUST
A=Altered mental state. Check for drugs or alcohol. M=Mechanism. Does the potential for injury exist? U=Underlying conditions. Are high-risk factors( e.g.,RA) for fxs. present? S=Symptoms. Is pain or paresthesia part of the picture? T=Timing. When did the symptoms begin in relation to the event
81
Key questions to guide framing of nervous system exam
1) Is the mental status intact? 2) Are your findings symmetric? 3) Where is the lesion?
82
Uber Motor Lesion
``` Hypertonia Hyperreflexia No fasciculation's No atrophy Positive Babinski ```
83
Lower Motor Lesion
``` Hypotonia Hyporeflexia Fasiculations Atrophy Normal plantar reflex ```
84
Most important part of shoulder reduction
relaxation of the shoulder musculature

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