Emergencies, osteoporosis, thoracic outlet Flashcards
(33 cards)
MC in leg and forearm
7Ps:
Pain (out of proportion)
Pallor
Paresthesias
Paresis
Poikilothermia
Pressure
pulselessness
compartment syndrome
Intercompartmental pressure > vascular perfusion pressure → ischemia of muscles, nerves, and vessels
Trauma
compartment syndrome
> 30 mmHg = absolute value
Perfusion pressure by subtracting compartment pressure from diastolic pressure
Pain out of proportion esp w/ passive stretching
compartment syndrome
compartment syndrome tx
Remove all restrictive dressings, splints, and casts
Refer for emergent fasciotomy
Acute onset of pain, swelling, and warmth in affected joint (knee = MC, hip in younger children)
Chills and fever
SC or SI joints = IVDA
RF: pre-existing joint disease
septic arthritis
Nongonococcal acute bacterial arthritis – hematogenous spread + direct inoculation (bacteremia, damaged joints, prosthetic joints, DM2, age, immune status, ulcers)
MCC = staph aureus
E. coli or pseudomonas in IVDA
septic arthritis
PE: look for any breaks in the skin, skin/tooth abscesses, all joints palpated/inspected
Hallmark = joint tenderness, effusion, erythema w/ marked limitation of passive motion
Joint held in flexion
Hips flexed + abducted
Labs: WBC, ESR, CRP
US = joint effusion
Aspiration → crystal analysis, gram stain, cell count, cultures w/ sensitivities
Blood cultures
Gonococcus = throat, cervical, urethral cultures
XR: AP/lat, usually normal but may show soft tissue swelling w/ widening of joint space
MRI to rule out osteomyelitis
septic arthritis
How do you treat septic arthritis
IV antibiotics after synovial fluid + blood cultures are obtained
→ IV ceftriaxone + vancomycin
Emergent surgical decompression + lavage of septic joint
Hospitalization
Prosthetic = may need removal and/or chronic suppression
50% spontaneously reduce before ED arrival → must reduce immediately if obvious deformity, especially if there are absent pulses
knee dislocation
High energy trauma (MVA, fall from height), or athletic injury
→ ¾ ligaments affected
Vascular + nerve injury common
– common peroneal nerve
Anterior MCC
Posterior → popliteal artery tear
Lateral → peroneal nerve
knee dislocation
Instability on exam
If pulses are absent = immediate surgery
XR: look for avulsion fx, asymmetric/irregular joint space
MRI
knee dislocation
How do you tx knee dislocation
Vascular consult, delayed ligament repair
Deformity, pain, loss of independence, premature bone death
Commonly seek medical care for: back pain, fracture, loss of height, spinal deformity
osteoporosis
What are RFs of osteoporosis?
White women > 50 years
Hip fracture
Age
Sex hormone deficiency
Alcohol
Smoking
Long term PPI use
High dose steroid use
Women + cola
Hypogonadal men
Anti-androgen therapy for prostate cancer
Multiple myeloma
Hyperthyroid + hyperparathyroid
Prolonged immobilization
Low bone strength from loss of bone density with inadequate bone mass/quality → deterioration
MC = vertebral fractures, hip, pelvis, wrist
osteoporosis
Blood tests for dx to screen for secondary causes – CBC, CMP, PTH, serum 25-V D, thyroid, hypogonadism celiac
Med adherence/efficacy: CTX (bone resorption), P1NP (bone formation)
osteoporosis
You should have a BMD to screen for osteoporsosis in
All women >/= 65 years and men >/= 70 years
Postmenopausal <65, transition, men 50-69
Adults with fragility fracture
Adults with conditions or medications ass w/ bone loss
Anyone considered for medication for osteoporosis
Anyone being treated for osteoporosis
Anyone not being treated but with bone loss would lead to treatment
best test for osteoporosis
DEXA: quick, painless, accurate to measure bone mass in density compared to peers (Z) and young (T)
T >/= -1 is normal
</= - 2.5 = osteoporosis
What predicts your 10 year risk of hip or other fracture
FRAX
Follow-up scan based on DXA:
-1 to -1.5 = 5 years
- 1.5 to -2 = 3-5 years
<-2 = 1-2 years
High dose prednisone = q1-2 years
You should do DEXA screening in patients — or with risk
> 65
Treatment for osteoporosis is reccomended in
women who have a T score <-2.5 who have already had a fracture or who have a high risk for fracture
non-pharm osteoporosis treatment
maximize bone formation during youth w/ proper diet + exercise = avoid tobacco/alcohol, minimize steroids
Older patients → maintain body weight, minimize caffeine treat visual impairments, prevention w/ exercise
pharm osteoporosis prevention
~ Vitamins → Vitamin D 600-800, calcium 1000-1200 (reserve for those with calcium-deficient diets)
~ Sex hormones → prevent, but do not treat, low dose transdermal estrogen, testosterone/estradiol (men)
