MS 2 Flashcards
(31 cards)
compartment syndrome
elevated tissue pressure causing decreased tissue perfusion, which can lead to necrosis of tissue and nerves
elevated tissue pressure causing decreased tissue perfusion, which can lead to necrosis of tissue and nerves
compartment syndrome
compartment syndrome - more common in what part of body
lower extremities and long bone fractures, especially tibial fractures
compartment syndrome - acute
life threatening emergency
compartment syndrome - hx and clinical presentation
5
- pain out of proportion to injury
- trauma
- burns
- prolonged compression of extremity
- snake bite
compartment syndrome - what are the 5 P’s
- pain
- pallor
- paresthesia
- paralysis
- pulselessness
compartment syndrome - the five P’s are considered what type of finding
late finding
compartment syndrome - physical exam
5
- perform motor and sensory exam
- discoloration
- assess compartment - may have tense “woody” feel on palpation, but not all compartments are directly palpable
- pain with passive stretch
- assess pulses
compartment syndrome - img/testing
3
- x ray if concerned for fx/foreign body
- measure compartment pressures if available - refer to ER if not
- consider urine myoglobin - but don’t delay ER transfer
compartment syndrome - tx
3
- keep NPO
- establish IV access if available
- analgesics
gout
uric acid in the blood causes monosodium urate (MSU) crystals to deposit into joints causing pain and inflammation
uric acid in the blood causes monosodium urate (MSU) crystals to deposit into joints causing pain and inflammation
gout
gout risk factors
4
- obesity
- alcoholism
- HTN
- certain meds i.e. diuretics
gout - sudden onset of
4
- severe pain
- swelling
- warmth
- redness of joint
gout - occurs more often, but not limited to what area
lower extremities
gout - percentage of location
2
75% monoarticular
50% involve MTP joint of great toe
gout - on physical exam you’ll find what of affect joint
5
inflammation
tenderness
erythema
swelling
warmth
gout - img/testing
- consider x ray if suspicion for trauma, osteomyelitis, or foreign body
- fluid aspiration if available to assess for crystals under light
gout - uric acid levels
not sensitive or specific in acute gout - don’t need to order
gout - DD
6
- OM
- septic arthritis
- cellulitis
- RA
- OA
- bursitis
gout - tx (none rx)
4
- rest
- ice
- elevate joint
- lifestyle changes
gout - diet modifications
6
avoid foods high in purines
red meats
organ meats
seafood
asparagus
spinach
gout - lifestyle changes
2
- limit alcohol
- weight reduction
gout - rx
3
- NSAIDs (naproxen, 500 mg BID PO, max 1500 mg day; script only for this higher dose)
- oral colchicine (adjust dose for those taking P-gp inhibitors)
- oral corticosteroids (prednisone 30 mg/day x 5 days)
*NSAIDs and prednisone have been shown to be equally as effective. Consider pt preference and tolerance. NSAIDs contraindicated in kidney disease eGFR <40, uncontrolled HTN, GI ulcers.
